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 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