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2008 Medicare Plus Blue Enrollment

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Enroll online in 2008 plans now.
 

It's easy to enroll in our individual Medicare Plus Blue plans. Just use the Medicare Plus Blue enrollment form to sign up for any of our four Medicare Plus Blue Medicare Advantage plans. Refer to Summary of Benefits for a description of each plan. For detailed benefit information, refer to Evidence of Coverage.
 

Download Enrollment Form Below

Please select the form below. You will be presented with the enrollment form for Medicare Plus Blue. Fill out the form and be sure to make a copy of it to save for your records. Put the form in a stamped 9" x 11" envelope and return to us at:
 

Blue Cross Blue Shield of Michigan
Medicare Plus Blue Enrollment
P.O. Box 440
Southfield, MI 48037-9953
 

Plan	Enrollment Form
Medicare Plus Blue pre-enrollment booklet	Pre-enrollment booklet (4.2MB - PDF)
Medicare Plus Blue enrollment form	Enrollment Form (73K - PDF)
Automatic deduction form	Deduction Form (29K - PDF)

Important Reminders:

• Do not send us your enrollment form until November 15, 2007.
• You must be a permanent resident of Michigan.
• You will need one form for each person enrolling in a plan.
• You can only enroll in one Medicare Plus Blue plan.
• Do not enclose payment with your enrollment form. We'll bill you or, if you requested it through use of the automatic deduction form, above, we'll automatically deduct your premium from your bank account. Social Security deductions can also be arranged after you have received a member ID card.
• If you currently have Medicare supplemental and/or prescription drug coverage from an employer group or union and are considering enrolling in Medicare Plus Blue, call your group benefits representative first to determine if you need this coverage.
   

To Complete an Enrollment Form We Sent You:

If you received an enrollment form in the mail from us, please fill it out completely. Be sure to check which plan you want to enroll in and to save a copy for your records. Put the completed enrollment form (do not fold it) in the 9" x 11" postage-paid envelope we sent you and mail it back to us. If you have not received this enrollment form, you can call us for one or download the appropriate enrollment form from this Web site.
 

Medicare Plus Blue is a private fee-for-serve plan with a Medicare contract. Medicare Plus Blue is available to all Medicare beneficiaries who are Michigan residents with Medicare Part A and Part B. Premiums vary by county. Medicare Plus Blue is issued by Blue Cross Blue Shield of Michigan.
 

A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan's terms and conditions prior to providing health care services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma.
 

You can also read more about how private fee-for-service plans work for you in our downloadable flyer (164K PDF).
 

The person that is discussing plan options with you is either employed by or contracted with Blue Cross Blue Shield of Michigan (BCBSM ). The person may be compensated based on your enrollment in a plan.