UEBT Active Other Insurance Information (OII) Form
UEBT Retiree Other Insurance Information (OII) 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
Blue Shield/PPO International Claim Form
Blue Shield Claim Form - Provider Who Does Not Bill
Dismemberment and Loss of Sight Form
Uprise Health (HMC) Claim Submission Form
UEBT Life and Accidental Death Claim Application