Forms and Tools

Authorized Delegate

This form is used for you to give Blue Cross permission to share your protected health information with another person or company.

Other Coverage Questionnaire

This secure web-based form lets us know if you or any of your dependents are covered by another health insurance plan or Medicare in addition to your Blue Cross or HMO Louisiana coverage.

Important note: You need to provide this information once every two calendar years in order for us to process your claims. If we do not have a current form on file for you and any dependents, we cannot process any of your claims.