Blue Cross Blue Shield of Michigan Individual Billed Member Change of Status Request Form

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.

Access the form here: Blue Cross Blue Shield of Michigan Individual Billed Member Change of Status Request form (PDF)

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
	Fax: 1-866-392-7528

Related Items

• Change of status form (for members with employer-sponsored health plans)
• Blue Care Network individual member change of status form
• Change of status form - Spanish language