Claim Forms

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you recently visited a doctor outside of your network and you need to submit a claim, you can use one of these claim forms.

Even if you have medical, vision, dental or prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, there may be occasions when you have to pay for services yourself. For example, you have to see an out-of-network doctor that doesn’t accept your insurance.

You can use these claim forms to ask us for reimbursement. Just choose the form based on your group or plan and the service. You’ll go to a page that explains the form and has a link to download it. Sometimes the form is called Member Application for Payment Consideration, which is the same as a claim form. If you were on a cruise, you'll use the same claim form for reimbursement of medical expenses. 

If you have any questions, call the phone number on the back of your enrollee ID card or contact us and we'll help.

Medicare member?

You can find medical and prescription drug claim forms on our Medicare website.

Traveling outside of the U.S.?

Because you’re insured through Blue Cross Blue Shield of Michigan, you have access to Blue Cross Blue Shield Global Core

If you have to pay for medical services while out of the country, they have a claim form available you can use to ask for reimbursement for medical expenses you paid for while out of the country.

You'll need your enrollee ID card to log in to the site.

Follow these instructions to log in and get the International Claim Form:

  1. Enter the first three letters from your enrollee ID card
  2. Click Go
  3. On the next page, select Claim Forms
  4. Choose the appropriate international claim form