Forms Directory

See below for a general list of forms that can be downloaded or printed. Please use the filter buttons to help search for a specific form by category. Some forms may only be found behind your secure participant login.

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  • UEBT Active Premier Enrollment Form
  • UEBT Active Ultra Enrollment Form
  • UEBT Active Annual Verification Form
  • UEBT Active Other Insurance Information (OII) Form
  • Adopted or Step Child Verification Form
  • Appointment of Personal Representative Form
  • Authorization to Release Medical Information
  • Benefits Registration Form
  • Blue Shield UEBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
  • Blue Shield UCBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
  • UCBT Active Premier Enrollment Forms Packet
  • UCBT Standard Clerk's Helper Enrollment Forms Packet