The easy-to-use Form Finder from Blue Cross and Blue Shield of New Mexico is now home to over 900 forms for producers, employers and members. Form Finder is the source of truth for nearly all BCBSNM forms.
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Downloadable Forms for Small Groups (2-50 Employees)
Here are some commonly used forms and documents producers need for conducting business with Blue Cross and Blue Shield of New Mexico. To access more downloadable forms, please log in your Blue Access for ProducersSM account.
Using PDFs
Most of the forms below are in portable document format (PDF). To view these files, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader®. Other Adobe accessibility tools and information can be downloaded at access.adobe.com.
“Sign Now” Documents
Some documents have a “sign now” option. To review and sign a document electronically, select the "sign now" version. If you need to sign a document later, select the download version. Most versions are in PDF format, and some may also be available in Microsoft Word format.
Enrollment Forms for New Small Groups
| Form Name | Digital Form | Download |
|---|---|---|
| Group Enrollment Application/Change Form – use this form to apply for group coverage or make changes to an existing BCBSNM policy | sign now | download form |
| Group Enrollment Application/Change Form – Spanish | N/A | download form |
| 2025 Enrollment Package – includes Benefit Program Application (BPA), EGI Form, and Artifacts Documentation for new accounts effective 1/1/25 and after | sign now | N/A |
| 2025 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2025 | sign now | download form  download form |
| 2025 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2025; use this form to amend the original BPA | sign now | download form download form |
| 2024 Enrollment Package – includes Benefit Program Application (BPA), EGI Form, and Artifacts Documentation for new accounts effective 1/1/24 and after | sign now | N/A |
| 2024 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2024 | sign now | download form download form |
| 2024 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2024; use this form to amend the original BPA | sign now | download form download form |
Employer Group Information (EGI) Form – this form must be submitted with the BPA |
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Blue Balance Funded Quoting Eligibility Checklist |
N/A | download form |
Blue Balance Funded RFP Producer Application Form |
N/A | download form |
| Common Ownership Form – Small Group | N/A | download form |
Consumer Directed Health Accounts Enrollment and Change Form – Use this form to collect employee FSA elections if sending enrollment through BCBSNM to BenefitWallet, HealthEquity or HSA Bank. |
N/A | download form |
| Dependent Student Medical Leave Certification Form | N/A | download form |
| Disabled Dependent Authorization Form (for Group Plans) – Members with an employer-sponsored health plan should use this form to request continuation of coverage on their existing policy for a dependent who is incapable of self-support because of mental or physical impairment. Mail or fax the completed form to BCBSNM (see address and fax number at the top of the form). You can also use this form to add a disabled dependent to a new policy (include this completed form when you submit your enrollment application). | N/A | download form |
FSA Employer Setup Form – Flex – Submit an electronic copy of this form for each employer wishing to elect FSA integration with Flex. |
N/A | download form |
| Group Application Packet – New Mexico 2023 – Contains Group Transmittal Form, Life Insurance Application for Group Insurance, Fraud Notices, FICA Tax/W-2 Agreement Form | N/A | download form |
HSA Employer Setup Form – Flex – Submit an electronic copy of this form for each employer wishing to elect HSA integration with Flex. |
N/A | download form |
HSA/FSA Employer Setup Form – HealthEquity® – Submit an electronic copy of this form for each employer wishing to elect HSA and/or FSA integration with HealthEquity. |
N/A | download form |
HSA/FSA Employer Setup Form – HSA Bank® – Submit an electronic copy of this form for each employer wishing to elect HSA and/or FSA integration with HSA Bank. |
N/A | download form |
| Producer Transmittal Form – New Mexico 2023 | N/A | download form |
| Supplemental Employment Verification Form | N/A | download form |
Renewal Forms and Information
| Form Name | Digital Form | Download |
|---|---|---|
| 2025 Important Benefit Changes/Uniform Modification Notice – Identifies some of the most important benefit plan changes for the 2025 coverage year. | N/A | download form |
| 2024 Important Benefit Changes/Uniform Modification Notice – Identifies some of the most important benefit plan changes for the 2024 coverage year. | N/A | download form |
| Group Enrollment Application/Change Form – use this form to apply for group coverage or to make changes to an existing BCBSNM policy | sign now | download form |
| Group Enrollment Application/Change Form – Spanish | N/A | download form |
| 2024 Benefit Program Application (BPA) for New Small Groups 2-50 – for new accounts effective on or after 1/1/2024 | sign now | download form download form |
| 2024 Benefit Program Application (BPA) Amendment for Small Groups 2-50 – for renewing accounts with anniversary dates on or after 1/1/2024; use this form to amend the original BPA | sign now | download form download form |
| Affidavit of Domestic Partnership | sign now | download form |
| Statement of Termination of Domestic Partnership | N/A | download form |
| Medical Loss Ratio (MLR) Written Assurance Form - Complete this standalone form only for an existing group if one of these conditions applies: 1) the group is changing Church designation as defined by the IRS, or 2) it is a Church group wanting to change how the rebate is handled. | sign now | download form |
| Average Employee Count (AEC) Form | sign now | download form |
Medicare Secondary Payer (MSP) Form and Information
| 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 flier |
| MSP Fact Sheet | N/A | download fact sheet |
Miscellaneous Forms
| Form Name | Digital Form | Download |
|---|---|---|
| Coordination of Benefits Form | N/A | download form |
| Producer of Record Transfer Form | N/A | download form |
| Medicare Coordination of Benefits Form | N/A | download form |
Legal / HIPAA Forms
| 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 | N/A | download form |
| Standard Authorization Form and other HIPAA Privacy Forms | N/A | N/A |