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Blue Benefit MA Logo
  • Why BBA
    • About Us
    • About Self-Funding
    • Our Offerings
      • Custom Solutions
      • Medical & Dental
    • Compliance, Security & HIPAA
  • Our Services
    • Claims & Benefit Administration
    • Cost Management
    • Consumer Engagement & Care Navigation
    • Next Generation Analytics
  • Members
    • Forms
    • Provider Search
    • Claims Submission
  • Employers
    • Machine Readable File Links
  • Brokers
  • Providers
  • Member Portal Login
  • Home
  • Members
  • Forms

Forms

Need a form? Use the below forms and upload them on our secure portal.

Can't find what you are looking for? Contact us and speak with one of our members service representatives.

 

  • Affidavit of Domestic Partnership Status
  • Authorization to Release Information
  • Confidential Communications Request
  • Dental Claim Form
  • Disabled Dependent
  • Disclosure Accounting Request
  • HRA Claim Form
  • Medical Claim Form
  • Medical Travel Expense Reimbursement Claim Form
  • PHI Access Request
  • PHI Amendment Request
  • Vision Form
  • Waiver of Coverage Form
  • Wellness Form

Blue Benefit Administrators of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.

® Registered Marks of the Blue Cross and Blue Shield Association.

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101 Huntington Avenue, Suite 1300, Boston, MA 02199-7611 | 877-707-2583 (BLUE) | TTY Number Dial 711

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