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 #
N/A 2019 Individual Paper Application Checklist N/A
73447.1018 2019 Health Application/Change in Coverage – Use this health application for plans effective January 1, 2019. N/A
600001.1018 2019 Dental Application/Change in Coverage – Use this dental application for plans effective January 1, 2019. N/A
606465.1017 2018 Individual Paper Application Checklist N/A
73447.1017 2018 Health Application/Change in Coverage – Use this health application for plans effective January 1, 2018. N/A
600001.1017 2018 Dental Application/Change in Coverage – Use this dental application for plans effective January 1, 2018. N/A
Stock # / Date Account Maintenance Forms Oklahoma Form #
72008.0916 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
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