Order an Explanation of Benefits for an Employee

To order an Explanation of Benefits (EOB), please complete the information requested.

*All fields are required unless noted

Date of service:	From          To
Provider name:	Include All Providers
Type of claims requested	All claims      Dental      Pharmacy
Company name:
Your e-mail address:
Your business title:
Your phone number:	(Area code first)
Your name:
Employee's BCBSKS ID number:
Employee's name:
Patient's name:
Include all family members?	Yes (optional)
The explanation will be mailed to the employee within two business days.