Here are some commonly used forms for enrolling and maintaining your employer group coverage with Blue Cross and Blue Shield of New Mexico (BCBSNM).
To review and sign your request now electronically, select the sign now option below. Or you can download and save the form, to review and sign at a later date.
| Form Name | Digital Form | Download |
|---|---|---|
| Medicare Supplement Applications | N/A | N/A |
| Form Name | Digital Form | Download |
|---|---|---|
| Annual MSP Employer Acknowledgement Form (EAF) with Instructions on Completing the Form | sign now | download form |
| Information Regarding the MSP Statute | N/A | download flyer |
| MSP Fact Sheet | N/A | download fact sheet |
| Form Name | Digital Form | Download |
|---|---|---|
| Medicare Supplement ezBlue Payment Option Authorization Form | N/A | download form |
| Medicare Coordination of Benefits Form | N/A | download form |
| Form Name | Digital Form | Download |
|---|---|---|
| Power of Attorney for Health Care – Members can designate someone they trust to make health care decisions if they are unable to do so. Follow instructions on the form. | N/A | download form |
| Power of Attorney for Health Care - Spanish – Members can designate someone they trust to make health care decisions if they are unable to do so. Follow instructions on the form. | N/A | download form |
| Standard Authorization Form and other HIPAA Privacy Forms | N/A | N/A |
