成员小册子,形式 & 文档

To help you manage your benefits from 蓝十字数控

For Individuals and Families Under Age 65

蓝十字数控 members can file a claim, 对拒绝提供福利提出上诉, and learn more about their coverage depending on their type of plan.

不知道你需要什么? 登录蓝色连接 or call the customer service number on the back or your member ID card. 

索赔表单

索赔 for 好处 Received in North Carolina or Out-of-Network in the U.S.
Note: most providers in the 蓝十字数控 network will file a claim on your behalf.


索赔 for services received outside NC:


索赔 for benefits received outside the U.S.

For benefits received on a cruise ship while outside the country; please submit the domestic claim forms.

    上诉表格

    这些申诉表格是 unintended for appealing underwriting decisions. If you wish to appeal an underwriting decision, try one of the following:

    • Check your underwriting decision letter for appeal instructions.
    • 联系当地代理商.
    • 1点打给我们.

    好处文档

    额外的信息

    成员 log in to 蓝色的连接 for more information:


    关于交互式pdf文档: You can add your information directly on the form to complete it, 然而, completed forms cannot be saved. You can save a blank version of the form. We recommend printing a copy for 蓝十字数控 and one for your records. 查看您需要的PDF文档 Adobe Acrobat Reader,由Adobe免费提供.com.

    蓝色的医疗保险

    Forms and resources for 蓝色的医疗保险 HMO, 蓝色的医疗保险 PPO, and 蓝色的医疗保险 Rx (PDP) 成员.

    蓝色的20/20 Vision Benefit Booklets*

    *Information provided for employer group members