Font Size: A A A

Forms and Resources for Members

Forms and Resources for Members

Forms & Resources for Members

Applications:

For Customers under the age of 65 [PDF]
For Customers age 65 and older [PDF]

Sure Pay Authorization Form:

Rates:

Claims:

Medical Claim Form [PDF]
International Claim Form[PDF] Español [PDF]

Receiving Care While Away From Home:

For PPO Members [PDF]
For HMO (BlueSelect) Members [PDF]

Privacy:

BCBSAZ Confidential Information Release Form [PDF] Español [PDF]
BCBSAZ Confidential Information Release Form for HIV Related Information [PDF]
HIPAA Notice of Privacy Practices [PDF]

Commission/Compensation:

Sales Compensation Information [PDF]

Register for BlueNet

Register for BlueNet to access tools, resources and services available to our customers.