It's easy to enroll in our individual Medicare Plus Blue PPO plan. Enroll now, or use the Medicare Plus Blue PPO Enrollment Application form to sign up. Read the Pre-enrollment brochure, then refer to Summary of Benefits for a description of the plan. For detailed benefit information, see the Evidence of Coverage.
|Enrollment Information and Forms|
|Medicare Plus Blue PPO Pre-enrollment brochure||Pre-enrollment booklet (PDF)|
|Medicare Plus Blue PPO Enrollment Application form||Enrollment Application form (PDF)|
|Automatic Deduction form||Automatic Deduction form (PDF)|
Download Enrollment Application form
Please select the Medicare Plus Blue PPO Enrollment Application form above. 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 send it to us at:
Blue Cross Blue Shield of Michigan
Medicare Plus Blue PPO Enrollment
P.O. Box 44256
Detroit, MI 48244-0256
If you need more information, if you need information in another format, or to be referred to our foreign language line, contact Medicare Plus Blue PPO at 1-888-563-3307 from 8 a.m. to 9 p.m. Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14. TTY users call 711.
Also, you can visit our Member Services locations.
Medicare beneficiaries also may enroll in Medicare Plus Blue PPO through the Centers for Medicare and Medicaid Services Online Enrollment Center, located at www.medicare.gov.
- Do not send us your Enrollment Application form until Oct. 15.
- 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 plan.
- Do not enclose payment with your enrollment form. We'll bill you.
- If you request automatic deduction (use the form above), we'll automatically deduct your premium from your bank account each month via an electronic funds transfer (EFT). Please allow three to four weeks for processing your application. You may receive a premium bill during the time your application is being processed, so please pay the bill. Future monthly premiums will be automatically withdrawn from your specified account on the fifth day of every month.
- You may also choose to have your premiums deducted directly from your Social Security. Social Security deductions can only be arranged after you have received a member ID card. Medicare Plus Blue PPO will bill you monthly for two or more months until Social Security withholding begins.
- If you currently have Medicare supplemental and/or prescription drug coverage from an employer group or union and are considering enrolling in Medicare Plus Blue PPO, call your group benefits representative first to determine if you need this coverage.
To complete an Enrollment Application form we sent you
If you received an Enrollment Application form in the mail from us, please fill it out completely. Be sure to check which plan you want to enroll in and 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 website.