Helpful Resources

Member Handbook

Basic information on things like getting care, what's covered and solving problems with BCBSND.

Certificate of Insurance

Explanation of how your plan works. Or, can be used as proof of your coverage.

Authorized Representative Form

Give permission to others for ongoing access to your health information.

Prefer to download and mail your form?
Authorized Representative Form

Authorization to Release Information Form

Authorize limited access to your health information.

Prefer to download and mail your form?
Authorization to Release Information Form

Appeal Rights and Form

If you wish to appeal a decision made by BCBSND.

Continuity of Care application

Continuity of Care allows BCBSND members to continue receiving covered health care services for specific medical conditions from a non-participating or out-of-network provider. Request a review for continuing coverage for specific medical conditions from a non-participating or out-of-network provider. Complete this application with your physician and return it to BCBSND as soon as possible. 

Grievance Form

If you believe BCBSND has failed to provide services or discriminated in another way.

Medicaid Expansion Restricted Use Drug List

A list of Prescription Medications or Drugs that may be covered under the medical benefit and may require Precertification (Prior Approval) for Medicaid Expansion members.

Coordinated Services Program

Coordinated Services Program (CSP) Provider Change Form

Coordinated Services Program (CSP) Appeal Form