Get C-387 - Cbc Reimbursement Voucher - Capital Blue Cross

Filling out the C-387 - CBC Reimbursement Voucher is an essential step in getting reimbursed for eligible medical expenses. This guide aims to provide clear, step-by-step instructions for effectively completing the form online, ensuring users can navigate the process with confidence.

Follow the steps to complete the C-387 form successfully.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In Section I, enter your subscriber information, including your identification number, full name, mailing address, and group name. Ensure all fields are completed accurately to avoid processing delays.
3. In Section II, provide your signature and date. This certifies that the expenses are eligible under the Internal Revenue Code and confirms that you have not been reimbursed by any other source.
4. Complete Section III by detailing your medical or dependent care expenses. Include the date of service, provider's tax ID (if applicable), provider's name, expense description, and the amount you wish to be reimbursed. Make sure this section is fully filled out, as receipts alone are insufficient.
5. Attach your itemized receipts or Explanation of Benefits for verification. Note that credit card receipts do not meet IRS requirements.
6. Finally, submit your completed form by mailing it to P.O. Box 772402, Harrisburg, PA 17177-2402, faxing it to 866.682.2242, or emailing a scanned copy to FSAClaims@capbluecross.com. Ensure you keep a copy for your records.

Start filling out your C-387 - CBC Reimbursement Voucher online today for a smooth reimbursement process.