Forms and Information

Member Forms

If the form you are looking for is not listed below, contact us for assistance.

Childbirth Classes Claim Form

With the MyBlue App, you can file for reimbursement online.

Claim Summary Example

How to read a Summary of Health Plan Payments for medical services you’ve received.

Miscellaneous Forms

Continuity of Care Request Form

If your doctor is leaving our network.

Transition of Care for New Members

New members with out-of-network providers.

Travel Benefit Reimbursement Form

Under the medical benefits travel rider, Blue Cross Blue Shield of Massachusetts will reimburse members for certain expenses related to travel to obtain covered services other than routine or preventative care when access to those services is not...

Member Forms

Subscriber Claim Form

Claim Form Online Submission

International Claim Form

Wellness Reimbursement Form

Childbirth Classes Claim Form

Claim Summary Example

Miscellaneous Forms

Cost Estimate Checklist

Sample 1099-HC Form

Appeals & Grievances

Continuity of Care Request Form

Transition of Care for New Members

Travel Benefit Reimbursement Form

Prescription Forms

Express Scripts Prescription Drug Reimbursement Form

Prescription Drug Mail Order Form