Request for Reimbursement Preferred HRA Form
To file a request for reimbursement:
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Complete the form using one of the following options:
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Fill out the form online by downloading this version:
Request for Reimbursement Preferred FSA/HRA Form. -
Fill out the form by hand by downloading and printing this version:
Request for Reimbursement Preferred FSA/HRA Form.
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Fill out the form online by downloading this version:
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Send or fax the completed form to:
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Preferred Blue Accounts
P.O. Box 11586
Birmingham, Alabama 35202-1586
Fax 1 877-889-3610 (Toll Free)
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Preferred Blue Accounts
Preferred Blue Accounts Direct Deposit Service Form
To start the direct deposit service:
- Register online for the Preferred Blue Accounts Direct Deposit Service
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Complete the paper form offline by the following option:
- Download a Preferred Blue Accounts Direct Deposit Service Form
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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