Downloadable Forms

Here are some commonly used forms for conducting business with Blue Cross and Blue Shield of Oklahoma (BCBSOK). To access more downloadable forms, please log in to Blue Access for Producers (BAP).

Many of the documents found here are in PDF format. If you do not have Adobe^® Reader^®, download it free of charge at the Adobe website .

Enrollment/Change Forms

Individual Product Forms
Blue Transitions Application	65kB
BlueSelect Dental Application	115kB
Health Check and Simply Blue Individual Application and Change in Membership	2MB
Health Check and Simply Blue Change Form	78kB
Plan65 and Blue Plan65 Select Application	350kB
Simply Blue Producer Acknowledgement	66kB
Group Product Forms
151+ Benefit Program Application	273kB
151+ BlueLincs Benefit Program Application	246kB
2–50 Benefit Program Application Amendment (Existing Groups)	279kB
2–50 New Group Benefit Program Application	279kB
51–150 Benefit Program Application	295kB
51–150 BlueLincs Benefit Program Application	211kB
BlueSelect Voluntary Group Dental Contract	26kB
Deductible Credit Form for employees at enrollment	725kB
Enrollment Application/Change Form	130kB
Enrollment Application/Change Form — Spanish	207kB
Group Employer Medical Questionnaire	461kB
Request for Continuation Coverage (COBRA)	66kB
Request for Proposal Census Form (Small Group 2–50) — Excel	25kB
Request for Proposal (Small Group 2–50)	190kB
Tips for Submitting New Regulated Small Groups 2–50	288kB

Account Maintenance Forms

Individual Product Forms
Blue Transitions Debit Authorization Form	65kB
EZ Blue Payment Option Authorization Agreement	117kB
List Bill Agreement	273kB
Group Product Forms
Authorization For Automatic Commission Deposit	62kB
Checklist for Obtaining a Quote for New Groups 51–150	97kB
Checklist for Obtaining a Quote for New Groups 151+	95kB
Checklist for Submitting Sold Groups 151+	145kB
Checklist for Submitting Sold Non-regulated Groups 51–150	131kB
Common Law Marriage Affidavit	31kB
Dependent Student Medical Leave Certification Form	33kB
Oklahoma Supplemental Employment Verification Form	183kB
Student Certification Form	44kB

Medicare Forms

Medicare Secondary Payer (MSP) Employer Acknowledgment Form with Instructions	155kB
Information Regarding the Medicare as Secondary Payer (MSP) Statute	301kB
MSP Fact Sheet	388kB

HIPAA Privacy Forms