Blue Access for Producers
 

Downloadable Forms for Large Group 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 available as PDF files. Just click on the appropriate form and print it out, then fill out the form and mail it in. You will need the Adobe® Reader® to view the following forms. Download this free of charge at Adobe's site .

2014 LARGE GROUP FORMS (Groups of 151+)
Stock # / Date Large Group - Enrollment Forms and Change Forms Oklahoma Form #
70843.0913 Benefit Program Application 151+  N/A
-- BlueLincs Benefit Program Application 151+  N/A
-- BlueSelect Voluntary Group Dental Contract 151+  N/A
71856.0211 Checklist for Obtaining a Quote for New Groups 151+  N/A
72317.0811 Checklist for Submitting Sold Groups 151+  N/A
70313.0913 Enrollment Application/Change Form  N/A
600765.1213 Enrollment Application/Change Form - Spanish  N/A
70313.1011 2013 Enrollment Application/Change Form  - (for groups with coverage prior to 1/1/14) N/A
72179.1011 2013 Enrollment Application/Change Form – Spanish  - (for groups with coverage prior to 1/1/14) N/A
-- Deductible Credit Form for Employees at Enrollment  N/A
71268.1010 Request for Continuation Coverage  N/A
 
Stock # / Date Large Group - Miscellaneous Forms Oklahoma Form #
600844.0114 Affidavit of Domestic Partnership  N/A
10.290 (07/06) Common Law Marriage Affidavit  N/A
600448.0913 Small Group Important Timelines  N/A
 
Stock # / Date Medicare Secondary Payer (MSP) Form and Information Oklahoma Form #
21126.0913 Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form N/A
21094.0609 Information Regarding the Medicare as Secondary Payer Statute N/A
72875.0612 MSP Fact Sheet N/A
 
Stock # / Date Legal / HIPAA Forms Oklahoma Form #
09.01.13 Standard Authorization Form and other HIPAA Privacy Forms N/A