Documents & Forms

We've put together the most common documents and forms you might need for things like filing claims or reviewing your coverage. Start by choosing what kind of insurance you have from the list below.

Medicare with Medicaid (BlueCare PlusSM)

Annual Notice of Changes

The Annual Notice of Change describes the changes to your plan's costs and benefits from the previous year.

Evidence of Coverage

Download a complete list of your plan's coverage, cost and benefits, also called your Evidence of Coverage.

Grievances & Appeals

Use these forms to file an appeal about coverage or payment decisions, or to file grievance if you have concerns about your plan, providers or quality of care.

Summary of Benefits

Download a simplified list of your plan's benefits and coverage, also called the Summary of Benefits.