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. Click the blue "Showing __ Results" text at the top of the directory to see more forms.
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UEBT Active Other Insurance Information (OII) Form
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UEBT Retiree Other Insurance Information (OII) Form
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Appointment of Personal Representative Form
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Authorization to Release Medical Information
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Benefits Registration Form
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Blue Shield UEBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
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Blue Shield UCBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
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Blue Shield/PPO International Claim Form
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Blue Shield Claim Form - Provider Who Does Not Bill
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Dismemberment and Loss of Sight Form
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Uprise Health (HMC) Claim Submission Form
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UEBT Life and Accidental Death Claim Application