Forms
- Enrollment and Change Form 2023-2024 (pdf) (Our office cannot accept forms with credit card information by email. Please mail or bring directly to the address listed at the bottom of the form)
- Dental Reimbursement Form 2023-2024 (pdf)
- Department Authorization Form 2023-2024 (pdf) (for fellows and trainees only)
- Student Information Release Authorization Form 2023-2024 (pdf)
- Continuation of Coverage Form 2023-2024 (pdf) (Our office cannot accept forms with credit card information by email. Please mail or bring directly to the address listed at the bottom of the form)
Brochures
- Enrollment Brochure (pdf)
- Summary Plan Description: Plan 1 (pdf)
- Summary Plan Description: Plan 2 (Dependents Only) (pdf)
- Summary of Benefits & Coverage: Plan 1 (pdf)
- Summary of Benefits & Coverage: Plan 2 (Dependents Only) (pdf)
Blue Cross Online Portal
The online member portal offers one-stop convenience for all your health plan information, allowing you to:
- View your member ID card or order a replacement
- View claims and plan information
- Search for a network doctor, clinic, or hospital, by selecting the "Blue Cross AWARE" network
- Find estimated costs for common medical procedures
- Read and write patient reviews on medical providers
Member ID Mobile App
Access important health plan information wherever and whenever you want with the BlueCrossMN Mobile app. You’ll have convenient, on-the-go access to claim status, your member ID card, a search tool to find in-network care and more, including other health resources like Sharecare. Search for “BlueCrossMN Mobile” in your app store.
2022-2023 GAHP Forms, Brochures & ID Cards
Forms
- Enrollment and Change Form 2022-2023 (Our office cannot accept forms with credit card information by email. Please mail or bring directly to the address listed at the bottom of the form)
- Dental Reimbursement Form 2022-2023
- Department Authorization Form 2022-2023 (for fellows and trainees only)
- Student Information Release Authorization Form 2022-2023
- Continuation of Coverage Form 2022-2023 (Our office cannot accept forms with credit card information by email. Please mail or bring directly to the address listed at the bottom of the form)
Brochures
- Enrollment Brochure
- Summary Plan Description: Plan 1
- Summary Plan Description: Plan 2 (Dependents Only)
- Summary of Benefits & Coverage: Plan 1
- Summary of Benefits & Coverage: Plan 2 (Dependents Only)
Blue Cross Online Portal
The online member portal offers one-stop convenience for all your health plan information, allowing you to:
- View your member ID card or order a replacement
- View claims and plan information
- Search for a network doctor, clinic or hospital, by selecting the "Blue Cross AWARE" network
- Find estimated costs for common medical procedures
- Read and write patient reviews on medical providers
Member ID Mobile App
Access important health plan information wherever and whenever you want with the BlueCrossMN Mobile app. You’ll have convenient, on-the-go access to claim status, your member ID card, a search tool to find in-network care and more, including other health resources like Sharecare. Search for “BlueCrossMN Mobile” in your app store.