Blue Access for Producers
 

Downloadable Forms for Mid-Market Groups (51-150 Employees)


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 Groups 51-150, Medicare Secondary Payer (MSP) Form and Artifacts Documentation sign now External Link N/A
2017 Benefit Program Application (BPA) for Groups 51-150 – 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 Groups 51-150 – 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
2018 Enrollment Application/Change Form – use this form to apply for group coverage effective 1/1/2018 N/A download form Acrobat PDF
2017 Enrollment Application/Change Form – use this form to apply for group coverage (through 12/31/2017) or make changes to an existing BCBSOK policy sign now External Link download form Acrobat PDF
2017 Enrollment Application/Change Form – Spanish N/A download form Acrobat PDF
Checklist for Obtaining a Quote for New Groups 51-150 N/A download form Acrobat PDF
Checklist for Submitting Sold Non-Regulated Groups 51-150 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
NRMM Census Import Table – file must be saved before entering data N/A download form Microsoft Excel Spreadsheet

 

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
Request to Extend Coverage for Disabled Dependent sign now External Link 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 sign now External Link 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