How to Submit a Claim-Blue Cross and Blue Shield's Federal Employee Program

How to Submit a Claim

Here’s how to submit your claims for medical services and prescriptions.

Need to submit a claim? Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. (For example, if your service was provided on March 5, 2017, you have until December 31, 2018 to submit your claim). Keep in mind that you must first pay your provider directly for all services and then submit your claim to us for reimbursement. If you have questions, please contact your local Blue Cross and Blue Shield company.

Health Benefits Claims

If you use a provider outside of our network, you’ll need to complete and file a claim form to be reimbursed.

Use this form to submit a health benefit claim for services that are covered under the Blue Cross and Blue Shield Service Benefit Plan’s Standard and Basic Options. Submit a separate claim for each patient.

  • Download the health benefits claim form:

    PNG English   PNG Español

  • Complete the form following the instructions on the back. (You can fill the form in electronically or complete it by hand.)
  • Include itemized bills for covered services or supplies.
  • Print and mail the form to your local Blue Cross and Blue Shield company by December 31 of the year following the year you received service. Find your local company's address.

Dental Claims

Use this form to submit a claim to be reimbursed for services that are covered under Service Benefit Plan dental benefits. Submit a separate claim for each patient.

  • Download the dental claim form:

    PNG English

  • Complete the form following the instructions on the back. (You can fill the form in electronically or complete it by hand.)
  • Print and mail the form to your local Blue Cross and Blue Shield company by December 31 of the year following the year you received service. Find your local company's address.

Pharmacy Claims

Use these forms when you want to submit a claim for prescription drugs. Submit a separate claim for each patient.

  • Download the appropriate pharmacy claim form:
  • Complete the form following the instructions on the back. (You can fill the form in electronically or complete it by hand.)
  • Include pharmacy receipts for covered prescriptions.
  • Mail the form, along with your receipts, to:

    Service Benefit Plan
    Retail Pharmacy Program
    P.O. Box 52057
    Phoenix, AZ 85072-2057

Overseas Claims

Overseas members must file claim forms for any covered medical or pharmacy services received outside of the United States. Submit a separate claim for each patient.

Medical Claims
  • Download the overseas medical claim form:

    PNG English

  • Complete the form following the instructions on the back.
  • Include itemized bills for covered services or supplies.
  • You can submit this form and upload images of your itemized bills online, or mail a paper copy, along with your itemized bills, to:

    FEP Overseas Claims
    P.O. Box 261570
    Miami, FL 33126


Pharmacy Claims
  • Download the overseas retail prescription drug claim form:

    PNG English    PNG Español

  • Print and complete the form according to instructions on the front.
  • Attach pharmacy receipts for covered prescriptions.
  • You can submit this form and upload images of your receipts online, or mail the form, along with your receipts, to:

    Service Benefit Plan
    Retail Pharmacy Program
    P.O. Box 52057
    Phoenix, AZ 85072-2057

FEP BlueVision® Direct Reimbursement Claims

FEP BlueVision is supplemental coverage that you can purchase for an additional fee. It is not a part of the Blue Cross and Blue Shield Service Benefit Plan’s Standard or Basic Options.

Use this form to submit an out-of-network claim, along with copies of the provider’s bills. Submit a separate claim for each patient.

  • Download the FEP BlueVision claim form:

    PNG English

  • Print and complete the form following the instructions.
  • Ask your provider to sign your form.
  • Mail the completed form to:

    FEP BlueVision
    P.O. Box 2010
    Latham, NY 12110-2010