Filing a Claim

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Following are instructions for filing claims. Once your claim has been processed, you will receive an Explanation of Benefits (EOB). It will show you the breakdown of charges and payments, if any. If you have a question regarding a specific claim, please call the phone number on your EOB.
When you file a claim, always keep copies of what you submit.

Medical - TRS-ActiveCare (BCBS)

• Deadline: Must be filed within 12 months from the date of service.
• Mail to Blue Cross Blue Shield of Texas, P.O. Box 660044, Dallas, TX, 75266-0044.
• BCBS Medical Claim Form (96 KB)
• Medco Mail-Order Prescription Form (110 KB)
• Medco Retail Prescription Reimbursement Form (50 KB) - Use this form to be reimbursed for a retail prescription you paid for in full.

Non-Medical Alternate Plan

• Deadline: Must be filed within 12 months from the date of service.
• Mail to PISD Benefits Department, Attn: Alternate Plan Claims, 6301 Chapel Hill Blvd, Plano, TX, 75093.
• Alternate Plan Claim Form (9 KB)

Dental Plans

• Deadline: Must be filed within 12 months from the date of service.
• Delta Dental network dentists will file claims for you.
• Mail to Delta Dental, P.O. Box 1809, Alpharetta, GA, 30023-1809
• Delta Dental Claim Form (47 KB)

Flexible Spending Accounts

• Deadline: Flex claims, including all required documentation, must be received by FBA no later than 90 days following the end of the plan year August 31, or 90 days following the termination of your flex account.
• Claims can be mailed, e-mailed, or faxed as shown on the claim form.
• Flex Account Claim Form (17 KB)
• Form to Request Direct Deposit, Additional Cards, or E-mail Communication (20 KB)
• Flex Card Transaction Substantiation Form (417 KB)
• How to Use Your Flex Card (740 KB)

Vision Service Plan

• VSP in-network optometrists will file claims for you.
• If you use a non-VSP optometrist, use your itemized receipt to complete the Out of Network Reimbursement form at www.vsp.com . Print the completed form and mail to Vision Service Plan, Attn: Out-of-Network Provider Claims, P.O. Box 997105, Sacramento, CA, 95899-7105.
• Deadline: Out-of-network claims must be filed within 6 months from the date of service.

Disability Plan

• UNUM Disability Claim Form (512 KB)