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) or 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

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