BlueCard Worldwide International Claim Form - Spanish

Reclamo Internacional

Member Dental Claim Form

Vision Direct Reimbursement Claim Form

Vision claim form (Medicare)

Request reimbursement for eligible eye care services you've received. For members of Medicare plans.

Nondiscrimination Complaint Form

Prescription Drug Claim Form

Dental Claim Reimbursement Form (Medicare)

Worldwide Emergency or Urgent Care Benefit Claim Form

Use this form to request reimbursement for emergency or urgent care services received outside the United States.