My Health Toolkit®
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View your benefits, sign up for paperless Explanations of Benefits, check claims status and more.
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Do you need 2018 coverage? If so, please review, fill out and submit a 2018 application.
You can use this form to give us permission to release information to someone else. Please note that if you're a parent of a minor child, you can still get information about your child without having to complete this form.
You can use this form to:
There may be times when you travel outside our service area or receive services out of network and wish to file a claim. This is the form you use.
Use this form to receive your dental reimbursement.
Use this form if you need to appeal a claim on behalf of someone else.
Use this form to submit institutional and professional claims for covered services you receive outside the United States, Puerto Rico, Jamaica and the U.S. Virgin Islands.
We offer a variety of disease and health education programs for the entire family. Please complete this authorization form to participate.
HSA Bank is an independent company that offers health savings account (HSA) administration on behalf of BlueChoice HealthPlan.
This form gives us information about any other health coverage you may have that can affect how we pay benefits. This is also known as Coordination of Benefits (COB). You can complete this form online by logging into My Health Tookit®.
This form offers you the convenience of ordering your prescription drugs by mail.
This form is for people with an acute injury or illness. Members or covered dependents need to get approval for this short-term benefit.