This link will take you to a new site not afilliated with BCBSIL. It will open in a new window. To return to our Web site, simply close the new window. Refer to important information for our linking policy.
Medical
Dental
Other Forms
Acrobat® Reader software allows you to view and download the pdf files. If you currently don't have the software, you can get a copy from Adobe Systems Incorporated. 
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 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.
