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
- Application for Individual Coverage
Fill out this application to enroll in one of our plans for individuals and families.
- Summary of Benefits and Coverage
Our SBCs show the details of each plan we offer, including summaries of what's covered, benefits and out-of-pocket expenses.
- Benefits at a Glance
Do you need more information about a Blue Cross Blue Shield of Michigan or Blue Care Network health plan? Our benefits-at-a-glance documents can help you learn more about each plan's coverage.
Managing my account
- Change of Status Form for Group Plans
If you get your health plan through your employer, you can use this form to update us when you have any changes to your status.
- Blue Care Network Physician Selection Forms
This form is for members who have individual or family, or employer-sponsored coverage through Blue Care Network. Use it to select or change your primary care physician.
- Protected Health Information and Privacy Forms
Your privacy is important to us - and we want to make it easy for you to manage your PHI. Learn more about giving your consent to release your information here.
- Mail Order Drug Forms
If you have prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, we have the mail order forms you need.