Use this claim form to file for gym membership reimbursement (up to $18/month) if you are enrolled in an LISD Medical Plan.

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

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

Spanish Language version

2023 BCBS Dental Claim Form

Hearing Benefits Information with Phone Number

Hearing Benefits 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.

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

Filing a Qualifying Life Event through FFenroll