The following documents are in Portable Document Format (PDF). You will need Adobe Acrobat Reader to view these forms. If you do not have Acrobat Reader, click the Adobe logo at right to download the FREE program.

Individual & Family Forms:

Individual Enrollment Application Form

Exceptions to Standard Enrollment

Member Claim Form

Small Group Forms (2-50 Employees):

Small Group Employee Application

Affidavit of Domestic Partnership

Patient Claim Form

Small Group Employer Application

Small Group Change of Coverage Application

Small Group Benefit Modification Inquiry

Small Group Remittance Schedule

Large Group Forms (51+ Employees):

Member Claim Form

Prescription Drug Claim Form

Mail Order Prescription Drug Claim Form

Flexible Spending Accounts Claim Form

Go to the Blue Cross of California Website

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