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HealthyBlue 2.0 Claim Forms
If you need a form that is currently not available online, please call Member Services at the telephone number on your ID card.
| Medical Claim |
| Membership Change Request
If you buy insurance through your employer, please contact your employer to make changes. Changes will not be processed unless received from your employer. |
| eBilling (Automatic Debit) |
| International Claim Form
(For care received out of network area) |
| Coordination of Benefits
(Update your information on My Account) |
| Disability Certification |
| Outpatient Pre-Treatment Initial Authorization |
| Outpatient Pre-Treatment Re-Authorization |
| Advanced Directive Information Sheet |
| Maryland Advance Directive |
| Continuity of Care - Members in a Maryland Based Plan (PDF) |
| Continuity of Care BC - Provider Not in Network (PDF) |