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
OTC COVID Test Reimbursement Form for UEBT Blue Shield Plan Actives and Non-Medicare Retirees
OTC COVID Test Reimbursement Form for UCBT Blue Shield Plan Actives and Non-Medicare Retirees
OTC COVID Test Reimbursement Form for UEBT Medicare Retirees
OTC COVID Test Reimbursement Form for UCBT Medicare Retirees
Blue Shield International Claim Form
Blue Shield Provider who Does Not Bill Form
Dismemberment and Loss of Sight Form