Claims

HOW TO CLAIM FOR BENEFITS

When you obtain health service from a non-participating provider you will be required to pay in full for the service. The same applies when you obtain service from a participating provider without using your Blue Cross® health card. When this occurs you can submit a claim for the cost of services received, to the Blue Cross of Jamaica Limited office. Blue Cross® will reimburse you the amount provided for in the schedule of benefits except where exclusions apply. Once you submit a Claim Form, completed and signed by the provider along with our original receipt.

FILING YOUR CLAIMS

Once your Claim Form is properly completed, Blue Cross® will process your claim within 21 working days. Your Claim Form requires the following information:

• Your policy or member number
• Patient's full name
• Mailing address
• Date of service or treatment
• Diagnosis (type of illness or injury)
• Description of the type of visit, service or procedure provided (i.e. surgery, etc.)
• Details of laboratory service received
• Prescription drug claims MUST carry the name, strength, cost and amount of the drugs
• Charge for each treatment
• Other health insurance coverage
• For consultation, the specialist must enter the name of referring doctor
• Ensure that the provider and subscriber or dependent sign the Claim Form
• Attach original receipts, signed and stamped by the health care provider to the Claim Form
• For re-imbursement, indicate whether cheque should be held at Blue Cross® or mailed to you
• Mail or take your Claim Form to any Blue Cross of Jamaica Limited office

Your Claim Form is only valid if it is submitted immediately after you receive service or within 90 days of the date of the service.