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Forms and Materials

Request for Reimbursement Preferred Dependent Care Account Form

To file a request for reimbursement:

1. Download a Request for Reimbursement Preferred Dependent Care Account Form
2. Complete the form using one of the following options:
• Type the information in the necessary fields, then print the form
• Print the form and complete it by hand
3. Send the completed form to:
   • Blue Cross and Blue Shield of Alabama
     P.O. Box 11586
     Birmingham, Alabama 35202-1586
   • or fax to 1 205 220-7991

Preferred Blue Accounts Direct Deposit Service Form

To start the direct deposit service:

1. Download and print a Preferred Blue Accounts Direct Deposit Service Form
2. Complete the form and send with a cancelled or voided check to:
   
   Blue Cross and Blue Shield of Alabama
   P.O. Box 11586
   Birmingham, Alabama 35202-1586

This site and all contents are Copyright 2012 by Blue Cross and Blue Shield of Alabama,
an Independent Licensee of the Blue Cross and Blue Shield Association.