To submit your Health Benefits Claim Form, ensure that all sections are fully completed. Mail the completed form along with all required attachments to CareFirst BlueCross BlueShield, Mail Administrator, P.O. Box 14116, Lexington, KY 40512-4116. For quicker processing, you may also fax your documents to their designated fax number or submit online if your provider offers this option. Always keep copies of your submission for your records.

Key dates for the Health Benefits Claim Form include the submission deadlines for claims related to services received in 2024 and 2025. Ensure you are aware of your plan's specific deadlines to avoid any lapse in your coverage. Always verify with your insurance provider for the most accurate and up-to-date information.

The primary purpose of the Health Benefits Claim Form is to provide a structured process for individuals to submit their healthcare expenses for reimbursement. This form helps streamline the claims process, ensuring that necessary information is collected and reviewed efficiently. By submitting this form, patients can receive financial assistance for their medical services in a timely manner.

• 1. Identification Number: The unique ID assigned to the patient by the insurance provider.
• 2. Group Number or Enrollment Code: The code that identifies the patient's health plan.
• 3. Patient's Name: Full name of the patient receiving treatment.
• 4. Patient's Date of Birth: The birthdate of the patient.
• 5. Subscriber's Name: Full name of the insurance policyholder.
• 6. Daytime Telephone Number: Contact number for the subscriber.
• 7. Subscriber's Address: Complete address of the subscriber.

Failure to submit this form properly may result in delays or outright denial of your claim. It is crucial to ensure that all required sections are filled in and that all supporting documents are attached. Claims with incomplete information will be returned for correction.

• Incomplete Information: Claims submitted with missing information will be delayed as you will need to provide the necessary details.
• Missing Attachments: Without the required itemized bills, your claim cannot be processed.
• Incorrect Submission Method: Submissions sent to the wrong address can result in claims not being reviewed timely.

• 1. Routine Medical Visits: File a claim for any routine check-ups or consultations with a physician.
• 2. Emergency Services: Submit claims for emergency care received during an accident.
• 3. Out-of-Network Providers: Use the form for services from providers not within your insurance network.