Forms Directory

See below for a general list of forms that can be downloaded or printed. Please use the search bar or filter buttons to find a specific form. (Some forms may only be found behind your secure participant login.)

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  • Adopted or Step Child Verification Form
  • Appointment of Personal Representative Form
  • Authorization to Disclose Specific Protected Health Information (PHI)
  • Authorization to Electronically Transmit Information
  • Authorization to Release Medical Information
  • Benefits Registration Form
  • Blue Shield Claim Form - Provider Who Does Not Bill
  • Blue Shield/PPO International Claim Form
  • Blue Shield UCBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
  • Blue Shield UEBT OTC COVID Test Reimbursement Form for Actives and Non-Medicare Retirees
  • CA State Disability Insurance Form (EDD)
  • CA State Withholding Election Form