Forms

The following files are in PDF format. A free PDF reader, Adobe Acrobat, is available for download.

• BCBS Claim Form
• BCBS International Claim Form
• Midyear Enrollment form
• UHCS Access Request Form
• Request to Terminate NUSHP/Mid Year Adjustment Form
• Fitness Benefit Fact Sheet
• Weight Loss Benefit Fact Sheet
• Prescription Drug Claim Form
• Petition to Enroll NUSHP
• Petition to Add (Dependents)