Skip to content

Blue Choice

Blue Option

Here are the forms for Blue OptionSM. You can also access resources that will help you sell Blue Option, including our sales brochure and summaries of benefits and coverage.

 

2017 Application

Authorization for Automated Debit Entries

Authorization to Disclose Personal Health Information

Change Request Form

Claim Form

Direct Pay Employer Agreement

Direct Pay Enrollment Form

Direct Pay Master Agreement

Pharmacy Mail-Order Form