Blue Access for Producers
 

Downloadable Forms for Small Group Products (2-50)


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.

To review and sign your request now electronically, select the sign now option below. Or you can download and save the form, to review and sign at a later date.


Enrollment Forms and Change Forms


Form Name Digital Form Download
2017 Enrollment Package – includes 2017 Benefit Program Application (BPA) for New Small Groups 2-50, Employer Group Information (EGI) Form, and Artifacts Documentation sign now External Link N/A
2016 Enrollment Package – includes 2016 Benefit Program Application (BPA) for New Small Groups 2-50, Employer Group Information (EGI) Form, and Artifacts Documentation sign now External Link N/A
2017 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2017 sign now External Link download form Word Document
2017 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2017; use this form to amend the original BPA N/A download form Word Document
2016 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2016 sign now External Link download form Word Document
2016 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2016; use this form to amend the original BPA N/A download form Word Document
Employer Group Information (EGI) Form - (this form must be submitted with the BPA) sign now External Link download form Acrobat PDF
Oklahoma Universal Application sign now External Link N/A
2016 Enrollment Application/Change Form – use this form to apply for group coverage or make changes to an existing BCBSOK policy sign now External Link download form Acrobat PDF
Checklist for Obtaining a Quote for New Groups 2-50 N/A download form Acrobat PDF
Composite Rate Billing Method Declaration Form (2016) - for new and existing fully insured accounts (up to 50 employees). Includes Reference Guide to Composite Rating for 2016 Accounts. sign now External Link download form Acrobat PDF
Composite Rate Billing Frequently Asked Questions - FAQs about composite billing available for new and existing fully insured accounts (up to 50 employees), effective January 2016. N/A download form Acrobat PDF
Small Group Submission Checklist N/A download form Acrobat PDF
Deductible Credit Form for Employees at Enrollment N/A download form Acrobat PDF
Group Employer Medical Questionnaire N/A download form Acrobat PDF
Request for Continuation Coverage N/A download form Acrobat PDF
Request for Proposal Census Form N/A download form Acrobat PDF
Request for Proposal N/A download form Acrobat PDF
Supplemental Employment Verification Form sign now External Link download form Acrobat PDF

 

Miscellaneous Forms


Form Name Digital Form Download
Affidavit of Domestic Partnership sign now External Link download form Acrobat PDF
Common Law Marriage Affidavit N/A download form Acrobat PDF
Disabled Dependent Certification Form sign now External Link download form Acrobat PDF
Small Group Important Timelines N/A download form Acrobat PDF

 

Medicare Secondary Payer (MSP) Form and Information


Form Name Digital Form Download
Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form N/A download form Acrobat PDF
Information Regarding the Medicare as Secondary Payer Statute N/A download form Acrobat PDF
MSP Fact Sheet N/A download form Acrobat PDF

 

Legal / HIPAA Forms


Form Name Digital Form Download
Standard Authorization Form and other HIPAA Privacy Forms N/A N/A