Your Network

Click here to find a provider within the Blue Shield PPO Network in California.
Click here to find an in-network provider outside of California

 

Forms & Resources

Here you’ll find forms to help with the administration of your program, as well as a link to pay your
COBRA or Retiree payment.

Click here to make COBRA or Retiree Payments online.

Coordination of Benefits Questionnaire

If you’re covered by more than one insurance plan, please complete this form so we can prevent duplicate payments and keep healthcare costs under control.
Download Form

Medical Claim Form

If you’ve already received medical care and your provider isn’t billing us directly, please complete this form to request payment.
 
 
Download Form

Third Party Liability Questionnaire

If you’ve been injured and it was someone else’s fault, please complete this form so we can seek payment for your medical expenses.
 
Download Form

Authorization to Release Protected Health Information

If you’d like us to release your protected health information to another party, please complete this form to give us your permission.

Download Form