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Wyoming Educators' Benefit Trust
Managed by Willis Towers Watson
415 W. 17th Street
Suite 140
Cheyenne, WY 82001
(307) 634-5566

Blue Cross Blue Shield of Wyoming
1-800-210-6642
Individual Forms

Claim Forms:

Medical Claim Form

Delta Dental Claim Form

Prescription Drug Claim Form

VSP Claim Form

*Change Forms:

Address/Name Change

Dependent Cancellation

*Please submit all change forms to your Human Resources Department.

YourWyoBlue Flyers:

YourWyoBlue Member Portal

Claims Summary Flyer

Summary of Benefits & Coverage (SBC) Flyer

View & Print EOB Flyer

Prescription Coverage Flyers:

Accredo Brochure

Express Scripts Brochure

MyPrime Flyer

Participating Pharmacy Listing

Miscellaneous Forms:

ANew 360 Employee Flyer

BlueCard Flyer

Becoming a Better Consumer

BCBSWY HIPAA Form

Delta Dental HIPAA Form

How to Read Your Medical EOB

Other Insurance Questionnaire (Online Submission)

Other Insurance Questionnaire (PDF)

Prior Authorization Request Form

TruHearing Flyer

Wyoming Educators' Benefit Trust
Managed by Willis Towers Watson
415 W. 17th Street
Suite 140
Cheyenne, WY 82001
(307) 634-5566
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