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