Send a Letter of Instruction that includes the following information:

• Your member ID number from the front of your Highmark BCBS medical ID card. (The number is preceded by CQM.)
• State in the letter that the accompanying check is being sent due to an over-reimbursement of a claim.
• Include the amount being returned and an original signature.
  

Mail the letter of instruction and your check to:

BNY Mellon Investment Servicing (US) Inc.
101 Sabin St.
Pawtucket, RI 02860-1427

Important Notice:  When the letter does not accompany your check, the deposit will be made as a regular post-tax contribution, counting toward your annual limit. If you are contributing the maximum allowed throughout the year, these additional deposits will cause you to go over the maximum allowed. Penalties could be assessed.