Plan Documents and Forms
- Blue Cross Blue Shield of Michigan General Member Claim Form
Use this form to manually submit a claim for a medical, vision or hearing service if you're a Blue Cross Blue Shield of Michigan member.
- Blue Care Network Member Reimbursement Form
If you're a Blue Care Network or HMO member, please use this form to manually submit a claim for medical services.
- Dental Service Claim Form
Blue Cross Blue Shield of Michigan members can use this form to submit a claim for an out-of-network dental service.
Buying health insurance
- Application for Individual Coverage
Fill out this application to enroll in one of our plans for individuals and families.
- Summary of Benefits and Coverage
Our SBCs show the details of each plan we offer, including summaries of what's covered, benefits and out-of-pocket expenses.
- Benefits at a Glance
Do you need more information about a Blue Cross Blue Shield of Michigan or Blue Care Network health plan? Our benefits-at-a-glance documents can help you learn more about each plan's coverage.
Managing my account
- Change of Status Form
Employer-sponsored health plan members can use this form to update us when they have any changes to their status.
- Blue Care Network Physician Selection Form for Employer-Sponsored Plans
This form is for members who have employer-sponsored coverage through Blue Care Network. Use it to select or change your primary care physician.
- Protected Health Information and Privacy Forms
Your privacy is important to us - and we want to make it easy for you to manage your PHI. Learn more here.