Request for Reimbursement Preferred HRA Form

To file a request for reimbursement:

  1. Complete the form using one of the following options:
    1. Fill out the form online by downloading this version:
           Request for Reimbursement Preferred FSA/HRA Form.
    2. Fill out the form by hand by downloading and printing this version:
           Request for Reimbursement Preferred FSA/HRA Form.


  2. Send or fax the completed form to:
    Preferred Blue Accounts
    P.O. Box 11586
    Birmingham, Alabama 35202-1586
    Fax 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 by:
    1. Downloading 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
      ATTN: Treasury Operations
      450 Riverchase Parkway East
      Birmingham, AL 35244-2858
      or
      Fax 205 220-2795