[+] Feedback Language Assistance
Return to Ancillary Home Page
  • Return to Ancillary Home Page
  • Employers
  • Producers
  • Employees
  • Beneficiaries
  • COVID-19
  • open side navigation menuMobile Menu Icon
  • Home
  • Employers
    • Products and Services
      • Life
      • Short-Term Disability
      • Long-Term Disability
      • Disability / Medical Integration
      • Accidental Death and Dismemberment
      • Critical Illness
      • Accident
      • Enhanced Solutions: Education
      • Enhanced Solutions: Municipalities
      • Vision
    • Benefits Manager
    • Administrative Tools
    • Forms
  • Producers
    • Prospective Producers
    • Products and Services
      • Life
      • Short-Term Disability
      • Long-Term Disability
      • Disability / Medical Integration
      • Accidental Death and Dismemberment
      • Critical Illness
      • Accident
      • Enhanced Solutions: Education
      • Enhanced Solutions: Municipalities
      • Vision
    • Ancillary Producers Corner
    • Forms
  • Employees
    • Products and Services
      • Life
      • Short-Term Disability
      • Long-Term Disability
      • Disability / Medical Integration
      • Accidental Death and Dismemberment
      • Critical Illness
      • Accident
      • Enhanced Solutions: Education
      • Enhanced Solutions: Municipalities
      • Vision
    • Forms
  • Beneficiaries
    • Life Claim FAQs
    • Life Claim Checklist
    • Forms
  • COVID-19
    • FAQ
    • Business Resiliency Program
    • Contact Us

      Phone: 1-866-739-4090
      Email: AncillaryQuestionsMT@bcbsmt.com

  • Beneficiaries
    • Life Claim FAQs
    • Life Claim Checklist
    • Forms

Downloadable Forms

Download the forms you need.

  • Accidental Death & Dismemberment Claim Form
  • Accelerated Death Benefit Claim Form
  • Critical Illness Claim Form
  • Critical Illness Wellness Benefit Claim Form
  • Accident/Critical Illness Wellness Benefit Claim Form
  • Accident Claim Form
  • Life Insurance Claim Form
  • Life Insurance Claim Form - Spanish
  • Long-Term Disability Claim Form
  • Long-Term Disability Claim Form - Spanish
  • Short-Term Disability Claim Form
  • Short-Term Disability Claim Form - Spanish
  • Vision Claim Form
  • Waiver of Premium Claim Form
  • Long-Term Disability Conversion Kit
Legal and Privacy | Non-Discrimination Notice
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright Health Care Service Corporation. All Rights Reserved.

File is in portable document format (PDF). To view this file, 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 screen reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com

You are leaving this website/app ("site"). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.