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)

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.

Your Rights

You'll find notices and forms in this section that will help you understand your rights and responsibilities, and make requests related to those rights.

Annual Notice of Changes

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