Medical Forms & Info ¦¦  Prescription Forms & Info ¦¦ Misc. Forms & Additional Coverage

Blue Cross/Blue Shield Policy #:  P09614 (PPO) 
B09614 (HMO) 
                                                 OM9616 (Blue Cross Select; BCS)

Contact Information:

  • Blue Cross PPO & BCS member services: 1-800-541-2767 for any claim or benefit questions .

  • Blue Cross HMO Member services : 1-800-892-2803  for any claim or benefit questions .

  • Pharmacy Program: 1-800-423-1973

  • Mental Health/chemical dependency 1-800-851-7498: 
    Member must call prior to hospital admission or within 1 day of emergency admission.

  • To locate a participating PPO provider in your service area or when traveling : 1-800-810-BLUE (2583) 

  • Medical Services Advisory 1-800-232-7108: 
    For all Illinois PPO hospital admissions , hospital must call. 
    For all Illinois HMO, Primary Care Physician will call.
    For Non-PPO or Out of State Hospital Admissions
    , member must call three days prior to elective admission
    and within 1 day of an emergency admission.

Medical FAQ and Forms:  All forms in Acrobat .PDF format unless otherwise noted.

  1. Health care costs and helping to keep them affordable
  2. Blue Access Information Brochure
    Sign up for Blue Access for Members:
    Click Here for the BCBSIL website .
  3. BCBS BlueChoiceSelect Benefits Highlights
  4. BCBS BlueAdvantage Entrepeneur PPO Benefits Highlights
  5. HMO Description of Benefits


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Prescription Plan and Forms: All forms in Acrobat .PDF format unless otherwise noted.


I Need:

  1. What is a formulary?
             Blue Cross Formulary 2007
  2. To File a Prescription Drug Claim:                                           
    Blue Cross Prescription drug claim form
  3. To Know how to Order Prescription Drugs by Mail                
    Blue Cross Prescription Mail order brochure
  4. To Order Prescription Drugs By Mail & Fax the Request:   
    Blue Cross Prescription Mail order enrollment form :for  faxing
  5. To Enroll in the Prescription Mail Order :                               
    Blue Cross Prescription Mail order enrollment form

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Miscellaneous Forms and Info


I Need: 

  1. Information on the Vision Plan                   
    Metlife Vision Discount Guide
  2. Information on the Lasik Vision Correction Discount
    MetLife Vision Lasik Flyer
  3. To Waive Coverage by Blue Cross             
    Blue Cross Waiver form
  4. To Enroll in Blue Cross Medical Coverage   
    Blue Cross Enrollment Form
  5. To file a Medical Claim                                    
    Blue Cross Claim Form
  6. Information about Medical Coverage while I'm traveling      
    Blue Cross Away From Home Brochure
  7. To file a Medical Claim while I'm outside the U.S.                 
    BlueCross International claim form
  8. Information on Blue Care Connection                                     
    Blue Care Connection Info


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