Plan Forms and Documents

Looking for forms and documents? Here you'll find forms to complete enrollment, make payments and much more. We also have information to help employers, employees and agents make important decisions.

Choosing coverage

Blue Elect Plus℠ Self-Referral Option group decision maker brochure (PDF)

Find value, flexibility and more choices with Blue Elect Plus.

Healthy Blue Living℠ (PDF)

Healthy Blue Living is a wellness incentive plan. This plan rewards members with cost savings for learning more about their health and taking action to improve it.

Healthy Blue Living flyer for employers (PDF)

Help your employees learn how they can save on premiums and be proactive about their care.

Enrollment forms

New Enrollment and Change of Status form (PDF)

These conditions and instructions will help employees enroll in a new plan or change to a different one.

New Enrollment and Change of Status form in Spanish (PDF)

If you're enrolling a Spanish-speaking member, this is the form you'll need to enroll them in a new plan or change an existing one.

Employee Waiver form (PDF)

If an employee wants to waive coverage, they'll need to read and fill out this form.

Employee Waiver form in Spanish (PDF)

If you have a Spanish-speaking employee who wants to waive their coverage, have them return this form.

Managing my account

Group Administrative Manual (PDF)

Learn about the member enrollment process and the structure of Blue Care Network's health care system.

Blue Care Network Self Funded Group Exception Form (PDF)

This form is for Self-Funded ERISA and Self-Funded non-ERISA groups to fill out for payment exceptions.

Blue Care Network Group Fax on Demand form (PDF)

Use this form to request group and member publications.

Healthy Blue Living group administrative manual (PDF)

This reference guide provides valuable information to help you administer Healthy Blue Living and answer questions your employees may have.

Payment forms

BCN Authorization Agreement for Automatic Payments (PDF)

Fill out this form to authorize BCN automatic payments for groups.

Employer Group Authorization Agreement for Automatic Payments (PDF)

Employers can make automatic payments to Blue Cross after filling out and returning this form.

Agent Fee Payment Process (PDF)

Find out what the requirements are for enrollment in the Agent Fee payment process.

Agent Fee Processing Agreement (PDF)

Read and fill out this form for BCBSM agent fee processing.

Downloadable resources

Use these toolkits to educate your employees on how to get the most out of their health plan.

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TOOLKIT
COVID-19

Help your employees learn more about prevention, coverage and care of COVID-19

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TOOLKIT
Open enrollment

Help your employees understand how to enroll in a health care plan.

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TOOLKIT
Flu shot

Educate your employees on the importance of getting the flu shot during flu season.

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TOOLKIT
Using an online account

Help your employees learn how to manage their online account at bcbsm.com.

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