Skip to main content

Audience

Employers
Employers
Providers
Providers
Agents
Agents
Contact Us

Header utility menu

Contact Us

Members utility menu

Member Login

Main Navigation

Our Plans
Our Plans
Understanding Health Insurance
Understanding Health Insurance
Find Care
Find Care
Member Resources
Member Resources

Main navigation mobile

Home
Our Plans
Understanding Health Insurance
Find Care
Member Resources
Employers
Providers
Agents
Contact Us

Members utility menu

Member Login

Members utility menu

Member Login

Toggle Hamburger

Search

Type

Forms & Documents (3111)

Page (270)

editorial (127)

Bio (74)

News (32)

Plan (26)

Program (21)

Plan Type

Medicare (107)

Medical Assistance (Medicaid) (36)

Employer-Provided (16)

Individual & Family (14)

Dental (14)

Employer Provided (10)

Vision (6)

Prescription Drug (3)

1561 (3)

1576 (1)

Audience

Providers (2651)

Members (258)

Employers (73)

imws_002126-self-insured-complaint-appeal-form-imws_002126.pdf

Click the preview below to download the document.

imws_002126-self-insured-complaint-appeal-form-imws_002126.pdf preview

Footer Main Navigation

Our Plans
Understanding Health Insurance
Find Care
Member Resources

Footer Audience Navigation

Employers
Providers
Agents
Contact Us

Footer Utility

About Us
Newsroom
Blog
thrive. Magazine
Careers

Footer Secondary

Help
Legal & Privacy
Nondiscrimination Practices

Social

Facebook
LinkedIn
Instagram
YouTube

Third Party Website Icon: Please be aware when you are on the Blue Cross and Blue Shield of Minnesota (Blue Cross) website and see this Third Party Website icon, you will be connected to a third party site, whether via links provided by Blue Cross or otherwise, and you will be subject to the privacy policies of the third party sites. Blue Cross recommends careful consideration when using third party sites and to review the privacy policy of such sites prior to providing any personal information.

©2025 Blue Cross and Blue Shield of Minnesota. All rights reserved.
Blue Cross^® and Blue Shield^® of Minnesota and Blue Plus^® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.