Blue Cross Blue Shield of Michigan Individual Billed Member Change of Status Request Form
Who is this for?
If you're a Blue Cross Blue Shield of Michigan member and you have an individual health plan, use this form to let us know of any changes to your status, like address or name changes.
We want you to receive all the benefits you are entitled to, so it is important to keep your records accurate. If you're an individual health care plan member (you don't get your health insurance through an employer), use this form to tell about:
- Address changes
- Name changes
- Spouses or dependents that need to added or removed
- Coverage changes
If you have any questions, call the Customer Service number on the back of your enrollee ID card.
What you’ll need:
- Your enrollee ID card
- A printer to print the form
- An envelope and postage to mail the form, or a fax machine.
Complete the form and return it to us within 30 days of the change. Then fax or mail the form to:
|Blue Cross Blue Shield of Michigan
P.O. Box 44407
Detroit MI 48244-0407