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Medicare Supplement members effective 6/10 or later, click here.
Need to find a Doctor or Hospital? Check the Online Provider Directory.

What is BCBSGa's 360° Health® program?

A total-health solution that surrounds everyone with the help they need to live healthier, feel better and save money doing it.

Download Forms

Claim Forms  
Prescription Drug Claim Form
To find this form, members must visit the Express Scripts website after login to their health plan site. Click the link in the Refill a Prescription section after login. On the Express Scripts website, select the Claims Reimbursement Form from the Printable Forms section. 
HIPAA Forms  
Federal Employee Program (FEP) HIPAA Forms  
Life & Disability Forms  
Miscellaneous Forms  
If your doctor will no longer be in the BCBSGA network, you may have the option to continue to receive care for a limited time. Care should be related to treatment already begun for this spell of illness/problem or if you are pregnant and began prenatal care. Complete this form and provide to your doctor who will fill out and return to BCBSGA. You will receive a decision in the mail about continuing care with that doctor.  
Consumer Choice  
FSA Forms  
Away From Home Care Guest Membership Forms  
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.