• ABOUT
    • General Information
    • Learn About the Plans
  • HIGHLIGHTED BENEFITS
    • Fenway Health
    • Emergency Medical and Travel Assistance
    • Dental Savings Program
    • Compare Plans
    • Summary of Benefits
    • Summary of Benefits & Coverage
    • Pediatric Dental Benefits
    • Traveling Abroad
  • EFFECTIVE DATES & COSTS
    • Midyear Adjustment
    • Monthly Rates
    • UHCS Fee
  • ENROLLMENT
    • Waiver Deadlines
    • Open Enrollment
    • Spouse/Dependents
    • Qualified Late Enrollment
    • Unqualified Late Enrollment
  • FORMS
  • CONTACT US

Forms

The following files are in PDF format:

  • 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)