Qualification Forms

Standard Qualification Form

If you have a Blue Cross Blue Shield of Michigan plan that requires a qualification form, please use the following form. Your doctor will submit the form by following the instructions on the back.

What you’ll need

  • Your subscriber ID card, formerly known as enrollee ID
  • A printed copy of the qualification form
  • An appointment with your doctor to fill out the forms. Information will be needed from both you and your doctor.
  • If you have any questions, please contact us.

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