Home > Medicare Advantage 2008 > Prescription Blue Enrollment

2008 Prescription Blue Enrollment

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Enroll online in 2008 plans now.
 

It's easy to enroll in our individual Prescription Blue plans. Just use the Prescription Blue enrollment form to sign up for either of our two Prescription Blue 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 Prescription 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
Prescription Blue Enrollment
P.O. Box 3667
Southfield, MI 48037-9928
 

Plan	Enrollment Form
Prescription Blue pre-enrollment booklet	Pre-enrollment booklet (3.3MB - PDF)
Prescription Blue enrollment form	Enrollment Form (64K - PDF)
Automatic deduction form	Deduction Form (27K - 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 Prescription 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 Prescription 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.
 

Prescription Blue is available to all Michigan residents who are entitled to Medicare benefits under Part A or enrolled in Part B. Medicare beneficiaries may be enrolled in only one Part D plan at a time. Prescription Blue is a prescription drug plan issued by Blue Cross Blue Shield of Michigan, which has a contract with the federal government. People enrolled in a Medicare Advantage plan may not enroll in Prescription Blue unless they are a member of a private-fee-for-service plan that does not provide Medicare prescription drug coverage.
 

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.