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
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.