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Thanksgiving Hours
Please be advised our offices will close at 3 pm EST on Wednesday November 23rd and will remain closed on Thursday November 24th and Friday November 25th in observance of Thanksgiving. If you have any issues that need to be resolved prior to the holiday, please contact your account representative or our member services team. We will resume normal business hours on Monday November 28th.
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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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