Documents & Forms Results

International Claim Form

For Blue Cross Blue Shield Global Solutions (formerly GeoBlue) members (Note: Medicare members should use the Worldwide Emergency or Urgent Care Benefit Claim Form).

BlueCard Worldwide International Claim Form - Spanish

Reclamo Internacional

Nondiscrimination Complaint Form

Prescription Drug Claim Form

Worldwide Emergency or Urgent Care Benefit Claim Form - Medicare

For Medicare Supplement, Medicare Cost, and Medicare Advantage members. Use this form to request reimbursement for emergency or urgent care services received outside the United States.

Dental Claim Reimbursement Form (Medicare)

Dental Claim Reimbursement Form

Medicare Organ Transplant Transportation and Lodging Reimbursement Form

This form may be used for reimbursement of expenses as the result of a Medicare-approved organ transplant.