Medical plan applications
This application will allow you to apply in our medical plans and our Specialty plans (dental and vision plans) at the same time. For faster processing of English applications, save time and enroll your clients through our Quote & Apply tool below. Your bonus and commissions are accounted for.
Get an enrollment application for your clients who want to only enroll in a Blue Shield dental plan and/or vision coverage.
Current members can add dental and vision plans sold through Blue Shield to their existing policy by logging into their account and going to the Benefits page.
Make sure your clients are protected by adding individual term life insurance (ITL) to their portfolio of coverage with benefit amounts ranging from $10,000 to $100,000 including Accidental Death and Dismemberment (AD&D) coverage. ITL can be purchased with or without a medical, vision or dental plan, or AD&D coverage. However, AD&D coverage must be purchased with ITL coverage.
Subscriber's Statement of Claim form (PDF, 103 KB)
(Subscribers should use this form only when the provider of service does not submit a claim directly to Blue Shield)
International Claim form (PDF, 114 KB)
Download the Blue Shield Global Core International Claim form.
Vision Claim form (PDF, 419 KB)
Download a vision claim form for members using an out-of-network provider.
Life Insurance Claim form (PDF, 89 KB)
Download this claim form for clients with life insurance claims that require a Proof of Death.