Blue Cross Forms

Application Forms

• Application – Dental and Health (EN/FR)
• Application – Health (EN/FR)
• Application – For new hires when coverage not compulsory – Health/Dental (EN/FR)
• Application – For new hires when coverage not compulsory – Health (EN/FR)
• Application – Survivor Benefit for Actives
• Application – Retiree Health and Dental (EN/FR)
• Application – Retired WSD MGEU plan

Change Forms

• Blue Cross – Cancellation Request
• Blue Cross – Loss of Coverage Form
• Blue Cross – Notice of Change Form

Claim Forms

• Blue Cross – Health Benefits Claim Form
• Blue Cross – Dental Claim Form

Other Plan Forms

• Blue Cross – Glucose Monitoring – Special Authorization Request Form
• Blue Cross – Pre-Authorized Debit Application for Leave of Absence
• Blue Cross – Brochure for mybluecross
• Blue Cross – How to submit a claim in mybluecross