Downloadable Forms

Medical & Dental

(for expenses covered by Blue Cross/Blue Shield)

• Blue Cross/Blue Shield medical claim form
• Blue Cross/Blue Shield dental claim form

Spending Accounts

• Health care spending account claim form
• Dependent care spending account claim form
• ADP electronic funds transfer form

Prescription Drug Forms

• Medco Health prescription drug reimbursement form
• Medco Health home delivery pharmacy service order form