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Fast Forms – Online

Managing your health coverage plan is easy with the MyBlueKC Member Portal. Speed through the process of submitting insurance claims online and get reimbursed faster. If you don’t yet have a MyBlueKC account, create an account first.

The following forms can be found inside your MyBlueKC portal:

• Medical/Dental Claims
• Pharmacy Claims
• Blue Cross and Blue Shield Global Core International Claims

Prefer to submit your health insurance claim by mail?
Note: Review of your form and potential reimbursement will be slower than online submissions.

• Medical/Dental Claim Form | Download PDF
• Claim Inquiry Form | Download PDF
• Pharmacy Claim Form | Download PDF
• Blue Cross Blue Shield Global Core International Claim Form | Download PDF
• Travel Benefit Claim Form | Download PDF (Review your benefit documentation or call Customer Service to confirm you are eligible)

Sales Brochures

• 2023 Small Group Product Guide (Business with 2-50 employees)
• 2017-2018 Level Funding ASO (Business with 25-99 employees)

Applications

• Dental Product Application
• Dental Product Application (Spanish)
• Medicare Supplement Application

Short-Term Plans Up to 90 Days (without Rx)

• Download Application
• Download Application (Spanish)

Short-Term Plus Plans Up to 365 Days (with Rx)

• Download Application
• Download Application (Spanish)

Prior Authorization

• Prior Authorization Find A Form

Member Forms

• Complaint/Grievance
• 1095 A, B, & C Forms (select the 1095 Form option in the drop-down menu)