Plan Documents and Forms
- Blue Cross Blue Shield of Michigan General Member Claim Form
Use this form to manually submit a claim for a medical, vision or hearing service if you're a Blue Cross Blue Shield of Michigan member.
- Blue Care Network Member Reimbursement Form
If you're a Blue Care Network or HMO member, please use this form to manually submit a claim for medical services.
- Dental Service Claim Form
Blue Cross Blue Shield of Michigan members can use this form to submit a claim for an out-of-network dental service.
Buying health insurance
Managing my account
- Change of Status Form for Blue Cross Blue Shield of Michigan PPO Members with Individual Health Plans
Blue Cross Blue Shield of Michigan PPO members with individual health plans should use this form to change their address, name, family size or coverage.
- Blue Care Network Individual Member Change of Status Form
Blue Care Network members with individual health care plans should use this form to add members to their plan or change their address, name or coverage.
- Change of Status Form
Employer-sponsored health plan members can use this form to update us when they have any changes to their status.
- Blue Care Network Physician Selection Form for Employer-Sponsored Plans
This form is for members who have employer-sponsored HMO coverage. Use it to select or change your primary care physician.
- Protected Health Information and Privacy Forms
These forms are for managing protected health information, which is what we call your private medical information we have on file.