Blue Access for Producers
 

Downloadable Forms for Small 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 .

SMALL GROUP FORMS (Groups of 2-50)
Stock # / Date Small Group - Enrollment Forms and Change Forms Oklahoma Form #
OK-SG-P-BPA Rev 11/13 New Group Benefit Program Application 2-50  N/A
OK-SG-HP-BPA-A Rev 11/13 Benefit Program Application Amendment (Existing Groups) 2-50  N/A
600542.1013 Checklist for Obtaining a Quote for New Groups 2-50  N/A
OK SG EGI Employer Group Information (EGI) Form  - (this form must be submitted with the BPA) 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
70381.0708 Group Employer Medical Questionnaire  N/A
71268.1010 Request for Continuation Coverage  N/A
-- Request for Proposal Census Form  N/A
71889.0911 Request for Proposal  N/A
-- Supplemental Employment Verification Form  N/A
 
Stock # / Date Small 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