For Individuals and Families Under Age 65
蓝十字数控 members can file a claim, 对拒绝提供福利提出上诉, and learn more about their coverage depending on their type of plan.
不知道你需要什么? 登录蓝色连接 or call the customer service number on the back or your member ID card.
索赔 for 好处 Received in North Carolina or Out-of-Network in the U.S.
Note: most providers in the 蓝十字数控 network will file a claim on your behalf.
索赔 for services received outside NC:
索赔 for benefits received outside the U.S.
For benefits received on a cruise ship while outside the country; please submit the domestic claim forms.
这些申诉表格是 unintended for appealing underwriting decisions. If you wish to appeal an underwriting decision, try one of the following:
- Check your underwriting decision letter for appeal instructions.
连续性护理表格 – allows members and their dependents to continue receiving care from a provider who is no longer in the 蓝十字数控 network.
Order Certification of Health Insurance Coverage – for terminated (ended) policies
蓝十字数控 Member Authorization Form – authorization to disclose your protected health information (PHI) to anyone that you designate and for any purpose.
Student Leave of Absence Certification Form – certifies a dependent child has lost their student status at a postsecondary educational institution due to a leave of absence caused by a serious illness or injury. You may be able to continue their coverage. A physician must complete this form.
关于交互式pdf文档: You can add your information directly on the form to complete it, 然而, completed forms cannot be saved. You can save a blank version of the form. We recommend printing a copy for 蓝十字数控 and one for your records. 查看您需要的PDF文档 Adobe Acrobat Reader，由Adobe免费提供.com.