Request for Reimbursement Preferred Dependent Care Account Form

To file a request for reimbursement:

  1. Fill out the form online by downloading this version:
         Reimbursement Preferred Dependent Care Account Form.
  2. Fill out the form by hand by downloading and printing this version:
         Request for Reimbursement Preferred Dependent Care Account Form.
  • Send or fax the completed form to:
    Preferred Blue Accounts
    P.O. Box 11586
    Birmingham, Alabama 35202-1586
    Fax 205 220-7991 (Local)
    1 877-889-3610 (Toll Free)

Preferred Blue Accounts Direct Deposit Service Form

To start the direct deposit service:

  1. Register online for the Preferred Blue Accounts Direct Deposit Service
  2. Complete the paper form offline by the following option:
  • Download a Preferred Blue Accounts Direct Deposit Service Form
  • Complete the form and send with a cancelled or voided check to:
  • Blue Cross and Blue Shield of Alabama
    ATTN: Treasury Operations
    450 Riverchase Parkway East
    Birmingham, AL 35244-2858
    or Fax 205 220-2795

Preferred Blue Accounts Dependent Care Account Brochure

Download a Preferred Blue Accounts Dependent Care Account Brochure