BlueCross / BlueShield of FL

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Before submitting a claim form, check your benefits booklet or ask your benefits coordinator to make sure your coverage and/or account(s) are through Blue Cross.

Claim Forms

• Dental Services
• Flexible Spending Account (FSA) - Dependent Care
• Flexible Spending Account (FSA) - Medical Reimbursement
• Health Benefits within the U.S. - Use this form only when filing a claim for services you receive from an out-of-network physician or health care professional.
• Health Benefits Worldwide
• Health Reimbursement Account (HRA)
• Prescription Drug
• Vision - Healthy Vision Out-of-Network
• Vision - Standard Out-of-Network
  

Order Prescription Drugs by Mail

• Mail Order Prescription Drug Service
  

Other Forms

• Accident Questionnaire
• Authorization for Mental Health Providers to Release Medical Information
• Authorization to Disclose Protected Health Information
• Other Health/Dental Coverage Questionnaire for Coordination of Benefits

Obtenga información en español aquí.