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.
-
Authorization to Release Medical Information
-
Benefits Registration Form
-
Blue Shield UEBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
-
Kaiser Medicare Senior Advantage Disenrollment Form
-
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
-
Medical Benefits (Shingles Vaccination, Hearing Aid, CBD Oil, COVID OTC) Reimbursement Form
-
CA State Disability Insurance Form (EDD)
-
Personal Information Change Form - Health and Welfare