Browse by Topic

Browse by Plan Type

Other Help

Not finding what you need in this section for members and insurance shoppers? Check out our other help sections below.

BCBSMAN Prescription Drug Claim Form

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you're a Blue Cross Blue Shield of Michigan member and your Rx group is BCBSMAN, use this form if you've paid up front for prescription drugs that are covered by your insurance and you'd like to be reimbursed.

When you're getting a prescription filled, the pharmacy usually just bills us electronically.

However, sometimes you may have to pay up front for prescription drugs that are covered by your insurance. If the Rx group on your Blue Cross Blue Shield of Michigan enrollee ID card is BCBSMAN, you can use this form to ask us to pay you back for that expense.

What you’ll need

  • Enrollee ID card
  • Pharmacy receipts
  • A copier or scanner to make copies of receipts for you to keep
  • A printer to print the form
  • An envelope and postage to mail the form

If you have any questions, call the number on the back of your enrollee ID card, or please contact us.

Rx group number BCBSMAN reimbursement form (PDF)

Related Items

Was this content helpful?

Rate it

Submit >

One site. One stop.

Managing your health plan online
has never been easier. On the new bcbsm.com, all your account information is in one place and personalized, so it's more useful.
Even better, you can access it anytime, anywhere, from your mobile device.

I’d like to register

Log in to my account

©1996-2014 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information

Explanation of Level A Conformance
Better Business Bureau Online Seal of Reliability