Forms & Resource Center
The Forms & Resource Center contains some of the commonly used forms for our health plan members. These forms are for use across many plans and are therefore generic in presentation. For the most up to date forms that may have been customized for your unique health plan we invite you to register for an account by visiting the Members page.
Online Document Submission
Ready to submit your documents to BAS? From within the health portal we make it easy to submit any form to us online, simply scan or take a picture of the form, login to your health portal account and click the "Send Us Your Documents" link from the home screen. There it will auto-populate your information and allow you to attach the document and add any comments you would like. No envelope, No Stamps. No Waiting.
Forms
Below are a collection of forms you can click on to print, should you require assistance or have questions please do not hesitate to call:
800-843-3831
- Medical Claim Form
- Dental Claim Form
- Vision Claim Form
- COB Questionnaire
- Subrogation and Assignment Form
- Authorization of Release Form
- FSA Claim Reimbursement Form
- Dependent Care FSA Reimbursement Form
- HRA Reimbursement Claim Form
- Transit Claim Form
A PDF viewer is required to view this forms, if your computer does not have a PDF viewer you can download Adobe PDF Reader here.