Claim Forms

Who is this for?

If you paid out-of-pocket for services you think we should cover, use one of these forms to submit a claim to us.

When you go to a doctor or pharmacy outside your plan's network, you might have to pay for the visit or drug in full up front. But if you think we cover the service, you can ask us to reimburse you for what we owe. You'll just need to fill out one of these claim forms.

To get reimbursed for a flu or pneumonia shot, you'll need to fill out a Flu and Pneumonia Shots Reimbursement Form (PDF).

For all other claims, choose your health plan below to find the form and instructions for sending it in.

If you have any questions, call the phone number on the back of your Blue Cross ID card and we’ll help.

What you'll need:

  • Your Blue Cross ID card
  • Original receipts from your doctor, pharmacy, etc.