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.
- Prescription Drug Claim Forms
If you have prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, we have forms you can use to make claims.
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.
- 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.
- Blue Care Network Primary Care Physician Selection Form
You’ll use this form to select your primary care physician if you are enrolling in a Blue Care Network plan that's sponsored by your employer.