• BCBS Member ID Card Information

• Ameritas VSP Claim - Reimbursement Form for Vision Insurance Plan Members

• BCBS Wellness Claim Form
  Use this claim form to file for gym membership reimbursement (up to $18/month) - Employee must be enrolled in one of Lubbock ISD's Medical Plan(s) to be eligible for reimbursement.

• Claimant must include a log of 10 gym visits for one month, a receipt or contract showing gym membership payment and the completed claim form.

• Claimant has thirty (30) days to submit the claim (example - submit January in February, etc.) - after thirty (30) days, the claim will be denied.

• BCBS Medical Claim Form
  Use this form to file a claim with BCBS when your provider did not. (Out-of-Network)

  • Spanish Language version

• BCBS Dental Claim Form (for use for non-accepting Dentist BCBS Dental claims)

  • BCBS Dental Claim Form

• Hearing Group Claim Form - Ameritas

  • Hearing Benefits Information with Phone Number

  • Hearing Benefits Claim Form

• Living Better Diabetes Claim Form
  Diabetes claims MUST be submitted with all required documentation supporting the claim (i.e. pharmacy slips, receipts, etc.) along with the completed LBD form within sixty (60) days for processing.  CLAIMS SUBMITTED AFTER SIXTY (60) DAYS WILL BE DENIED. Additionally, the claimant MUST have completed the monthly educational program through iaWellness for the month in which the claim is being submitted. Additionally, you must have completed all the requirements to date to be received reimbursement for eligible diabetic claims expenses - PLEASE GO TO THE DIABETES PROGRAM INFORMATION LINK ON THE RISK MANAGEMENT WEBPAGE FOR A LIST OF ALL THE REQUIREMENTS TO PARTICIPATE IN THE LIVING BETTER DIABETES PROGRAM.

Qualifying Life Event Instructions Using FFenroll
See below for instructions on filing a Qualifying Life Event through FFenroll:

• Filing a Qualifying Life Event through FFenroll