Forms and Documents

Eligibility Form

• Disabled Dependent form

Medical Forms and Documents

• PPO medical claim form
• BCBS medical claim form (for BCBS National and BCBS Caterpillar NetWork)
• UHC international claim form (for claims incurred while traveling or living abroad, excluding ISEs)
• UHC out-of-network hearing aid claim form
• Cigna claim form (for International Assignees)
• Diabetic supplies FAQs

Prescription Drug Forms

• Caterpillar Prescription Drug Reimbursement Form
• External Review Process Form
• Prior Authorization Forms
• Prime PHI Authorization Form

Dental Forms

• Cigna dental claim form
• Cigna Dental PPO Network Nomination form or complete the online version

Vision Forms

• VSP claim form
• UHC claim form (for retirees who are enrolled in a UHC plan option that does NOT include vision coverage through VSP)

Safety Glasses Form and Document

• Instructions for submitting a claim
• VSP claim form

Flexible Spending Account Forms

• FSA claim form (Dependent Care)
• FSA claim form (Health Care)