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.

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SMALL GROUP FORMS (Groups of 2-50)
Stock # / Date Small Group - Enrollment Forms and Change Forms Oklahoma Form #
OK-SG-P-BPA Rev 11/14 New Group Benefit Program Application 2-50  N/A
OK-SG-HP-BPA-A Rev 11/14 2015 Benefit Program Application Amendment (Existing Groups) 2-50  N/A
600542.1013 Checklist for Obtaining a Quote for New Groups 2-50  N/A
10/2015 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. N/A
10/2015 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
602519.0215 Small Group Submission Checklist  N/A
OK SG EGI Employer Group Information (EGI) Form  - (this form must be submitted with the BPA) N/A
601863.0814 Enrollment Application/Change Form  N/A
602488.0115 Enrollment Application/Change Form - Spanish  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
602661.0315 Disabled Dependent Certification Form  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