Blue Access for Producers
 

Downloadable Forms for Individual Products

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.

The forms below are in portable document format (PDF). To view these files, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader®.

Current Individual Forms
Stock # / Date Enrollment Forms and Change Forms Oklahoma Form #
73447.0216 Health Application/Change in Coverage – Use this application for the 2016 plans, which are effective January 1, 2016. N/A
600001.0216 Dental Application/Change in Coverage – Use this application for the 2016 plans, which are effective January 1, 2016. N/A
Stock # / Date Account Maintenance Forms Oklahoma Form #
72008.0914 EZ Blue Payment Option Automated Premium Payment Authorization Agreement  N/A
Stock # / Date Legal / HIPAA Forms Oklahoma Form #
08.01.15 Standard Authorization Form and other HIPAA Privacy Forms N/A


Pre-ACA Individual Forms
Stock # / Date Enrollment Forms and Change Forms Oklahoma Form #
72120.1113 Health Check and Simply Blue Individual Application and Change in Membership  N/A
71269.1210 BlueSelect Dental Application  N/A
Stock # / Date Account Maintenance Forms Oklahoma Form #
70309.0209 Authorization Agreement  N/A
Stock # / Date Legal / HIPAA Forms Oklahoma Form #
08.01.15 Standard Authorization Form and other HIPAA Privacy Forms N/A