Member Benefits

Insurance Fund

Empire BlueCross BlueShield

P.O. Box 1407
Church Street Station
New York, NY 10008-1408
1-800-553-9603
www.EmpireBlue.com

Materials:

• Forms
  • Coordination of Benefits Form (C.O.B.) 
    
  • HIPAA Privacy Consent and Fund Beneficiary Designation Forms
  • Enrollment Form for Adult Children
  • Change of Address  
• Disclosures
  • Balance Billing Notice
  • Empire BlueCross BlueShield Directory
  • Summary of Benefits and Coverage