Claims Forms

Who is this for?

Learn more about claims forms.

If you get your health coverage through the UAW Retiree Medical Benefits Trust, use these forms to submit claims to us.

Medicare Advantage PPO and BCN Advantage plans

Here are the forms you need to ask us to pay you back for medical services.

Blue Care Network and Traditional Care Network plans

You'll find all the forms you need to ask us to reimburse you for medical services or prescription drugs here.