Forms

Medical Claim Form
When you go to a PPO or Point-of-Service doctor or hospital for your care, there's no need for you to pay up-front for your care (except your copayment). Instead network doctors and hospitals file claims on your behalf directly with Blue Cross and Blue Shield. You won't have to complete claim forms unless you use a doctor or a hospital that is not part of the PPO or Point-of-Service networks. In those cases, you can download our online Medical Claim Form.

Prescription Drug Claim Form
For HMO option members in Ohio and Illinois only.
Pharmacists will file your claim directly with us. In the few instances where you may need to file the claim yourself, you can download our Prescription Claim Form.