Here's the group form: Blue Care Network Primary Care Physician Selection form - Group (PDF)

What you'll need:

  • A printer to print the form 
  • An envelope and postage to mail the form, or a fax machine. Each form includes instructions, a mailing address and a fax number.

Step by step instructions:

  1. Select your primary care physician. If you need help finding one, use to find a list of doctors that participate in Blue Care Network. 
  2. Fill out the form completely. Check with your employer to find out if you should return the form to them first before mailing it to us. 
  3. Complete the form, sign and return it to us along with your Subscriber New Enrollment form. Return this form as soon as you enroll so that we can notify your doctor of your membership.

Fax or mail the form to:

Membership and Billing – M.C. C411
Blue Care Network
P.O. Box 5043
Southfield, MI 48086
Fax: 1-877-218-1466

If you have any questions, please contact your employer.