Filing CHCBP Claims

If you visit a network provider, the provider will files claims for you. If you have to file your own claim, you should send your claim form as soon as possible after you receive care. The sooner your claim and other paperwork are received, the sooner you or your provider will be paid.

• In the U.S. and U.S. territories, claims must be filed within one year of service.
• In all other overseas areas, claims must be filed within three years of service.

To file a claim:

1. Download and fill out the Patient's Request for Medical Payment form (DD Form 2642).

2. Attach a readable copy of the provider’s bill to the claim form. Make sure the bill contains the following:

• Sponsor’s Social Security number (Eligible former spouses should use their own Social Security number.)
• Provider’s name and address (If more than one provider’s name is on the bill, circle the name of the person who treated you.)
• Date and place of each service
• Description of each service or supply furnished
• Charge for each service
• Diagnosis (If the diagnosis isn’t on the bill, be sure to complete block 8a on the form.)

3. Fill out all 12 blocks of the form correctly and sign it.

4. Make a copy of the paperwork for your records.

5. Mail or fax your completed claim form and supporting documents to: 

CHCBP Claims
P.O. Box 202146
Florence, SC 29502-2146

Fax: 877-489-0007