FSA Plan for UCC Ministries Change in Status Election Form
Highmark Member Submitted Claim Form(for reimbursement of medical services.)
Highmark Shingles Claim Form(for reimbursement of the Shingles vaccine)
BlueCross BlueShield International Claim Form (for reimbursement of foreign medical care only)
Pharmacy Service Claim Form--Please contact Express Scripts at 1.800.939.3781 or log in to your account at www.express-scripts.com to access member submitted pharmacy claim forms.