Retiree Drug Subsidy Online Renewal Questionnaire

If you have any questions about this questionnaire, please send an email message to rdsdesignee@bcbsm.com.

Plan information (from RDS application)

NEED A DATE PICK COMPONENT

NEED A DATE PICK COMPONENT

Group number(s)

BCBSM

BCN


General contact information (from RDS application)

Has the contact information changed?

Payment Setup

Is BCBSM named as vendor using vendor number A0013?

Is file submission mainframe to mainframe?