Forms and Documents

These forms and documents are available as PDF files. Just click on a form or document to download it. You may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe^® Reader^® which has a built-in reader. You can download this at Adobe's site.

Download Documents

Member Handbooks

Member Handbook for Blue Cross Community Health Plans (BCCHP)
English – Spanish – Arabic – Gujarati – Polish – Ukrainian

Member Handbook for Health Benefits for Immigrant Adults/Seniors (HBIA/HBIS)
English – Spanish – Arabic – Gujarati – Polish – Ukrainian

Member Handbook for Managed Long Term Supports and Services (MLTSS)
English – Spanish – Arabic – Gujarati – Polish – Ukrainian
Over-the-Counter (OTC) Benefits Catalog

OTC Benefits Catalog for BCCHP and HBIA/HBIS

OTC Benefits Catalog for MLTSS
Preferred Drug List

Preferred Drug List (PDL) for BCCHP and HBIA/HBIS
Pharmacy Directory

Pharmacy Directory for BCCHP and HBIA/HBIS
Provider Directories

To download medical provider directories for all plans, go to Find a Provider.
Long-Term Supports and Services (LTSS) Waiver Handbook

LTSS Waiver Handbook for BCCHP and HBIA/HBIS
English – Spanish – Arabic – Gujarati – Polish – Ukrainian
Other Waiver Handbooks

Brain Injury Waiver Handbook

Disabilities Waiver Handbook

Elderly Waiver Handbook

HIV/AIDS Waiver Handbook

Supportive Living Waiver Handbook
Health Benefits for Immigrant Adults and Seniors (HBIA/HBIS) Resource Guide

Resource Guide for Health Benefits for Immigrant Adults/Seniors (HBIA/HBIS)
Youth In Care Program Flier

Illinois Department of Children and Family Services (DCFS) Youth In Care Program Flier for all plans
English – Spanish – Arabic – Gujarati – Polish – Ukrainian
Additional Documents

Frequently Asked Questions

HIPAA Notice of Privacy Practices

Member Rights and Responsibilities

Non-Discrimination Notice and Language Assistance

Download Forms

Authorized Representative Designation Form

Critical Incident Form for Members

Express Scripts^® Home Delivery Registration and Prescription Mail-Order Form

HIPAA Standard Authorization Form and other Privacy Forms

Power of Attorney for Health Care Form

Find a Provider

Use our Provider Finder^® to search for doctors and other providers.

Need Help?

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The call is free.