Most common forms

Employee Demographic Update Form

Submit form to change employee name or address.

Employee Cancel Form

Submit form to cancel coverage.

Member Claim Form

Assist an employee in filing a claim for medical services.

Billing and payments

Electronic Funds Transfer (EFT) Authorization Agreement
Complete bank information and attach a copy of a cancelled or voided check to verify account and routing/transit numbers. Payment withdrawals from your bank account will be completed on the 1st of the month. Billing schedule is subject to change due to holidays and weekends.

Fully Insured Billing Guide
Guide to your invoice and billing package.

2026 Self-Funded Billing Calendar
For self-funded groups, download the calendar to see when your bill is due and when claim expense reports become available. 

Eligibility and renewals

2025 Medical Loss Ratio (MLR) Form
Submit the MLR form, as required by the Affordable Care Act (ACA).

Employee Demographic Update Form
Submit this form to change an employee's address or update an employee's name.

Employee Cancel Form
Submit this form to cancel an employee's coverage.

You may also be able to complete these change online faster and easier within the Employer Portal.

Health Affiliation and OOA Waiver
If you offer a health plan that requires the selection of a specific network, use this form to:

• Choose a network
• Change network at renewal, or one other time in the year
• Put a waiver on a covered family member who may reside outside the network service area

Creditable and Non-Creditable Coverage Mandates

Confirm the Rx creditable status of BCBSND health plans.

2026 Creditable and Non-Creditable Coverage Mandates

2027 Creditable and Non-Creditable Coverage Mandates

New York Health Care Reform Act

Get more details about the New York Health Care Reform Act, including how it affects self-funded employer groups in North Dakota and reporting requirements.