Blue Access for Producers
 

Downloadable Forms for Small Groups (2-50 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
2019 Enrollment Package – includes Benefit Program Application (BPA) for New Small Groups 2-50, Employer Group Information (EGI) Form, and Artifacts Documentation sign now External Link N/A
2019 Benefit Program Application (BPA) for Small Groups 2-50 – for new accounts effective on or after 1/1/2019 sign now External Link download form Word Document
download form Acrobat PDF
2019 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2019; use this form to amend the original BPA N/A download form Word Document
download form Acrobat PDF
2019 Enrollment Application/Change Form – use this form to apply for group coverage effective 1/1/2019, or to make changes to an existing BCBSOK policy N/A download form Acrobat PDF
2018 Enrollment Package – includes 2018 Benefit Program Application (BPA) for New Small Groups 2-50, Employer Group Information (EGI) Form, and Artifacts Documentation sign now External Link N/A
2018 Benefit Program Application (BPA) for Small Groups 2-50 N/A download form Word Document
2018 Benefit Program Application (BPA) Amendment for Small Groups 2-50 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
2018 Enrollment Application/Change Form – use this form to apply for group coverage effective 1/1/2018, or to make changes to an existing BCBSOK policy sign now External Link download form Acrobat PDF
2018 Enrollment Application/Change Form – Spanish N/A download form Acrobat PDF
2017 Composite Billing Guide and FAQs – for new and existing fully insured accounts (up to 50 employees) N/A download guide Acrobat PDF
Checklist for Obtaining a Quote for New Groups 2-50 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

 

Renewal Forms

Form Name Digital Form Download
2019 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2019; use this form to amend the original BPA N/A download form Word Document
download form Acrobat PDF
2019 Enrollment Application/Change Form – use this form to apply for group coverage effective 1/1/2019 N/A download form Acrobat PDF
2019 Significant Benefit Changes to Select Small Group Plans – for accounts renewing 1/1/19 and after N/A download letter Acrobat PDF
How to Save Money on Your Renewal flier N/A download flier Acrobat PDF
2018 Benefit Program Application (BPA) Amendment for Small Groups 2-50 N/A download form Word Document
2018 Enrollment Application/Change Form – use this form to apply for group coverage effective 1/1/2018, or to make changes to an existing BCBSOK policy 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
Request to Extend Coverage for Disabled Dependent 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 sign now External Linkdownload 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