It's easy to enroll in our individual Medicare Plus Blue PFFSSM plans. Contact us to enroll, or use the Medicare Plus Blue PFFSSM enrollment form below to sign up for any of our Medicare Plus Blue PFFSSM plans. Refer to Summary of Benefits for a description of each plan. For detailed benefit information, refer to Evidence of Coverage.
Download Enrollment Form Below
Please select the form below. You will be presented with the enrollment form for Medicare Plus Blue PFFSSM. 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 return to us at:
Blue Cross Blue Shield of Michigan Medicare Plus Blue PFFSSM Enrollment
P.O. Box 440
Southfield, MI 48037-9953
Fax: 248-448-4041
You may request the Medicare Plus Blue PFFSSM enrollment form in alternative formats by calling 1-877-469-2583 from 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704).
Medicare beneficiaries may enroll in Medicare Plus Blue PFFSSM through the Centers for Medicare and Medicaid Services Online Enrollment Center, located at medicare.gov.
Please remember:
Do not send us your enrollment form until November 15, 2009.
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 or, if you requested it through use of the automatic deduction form, above, we'll automatically deduct your premium from your bank account. Social Security deductions can also be arranged after you have received a member ID card.
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 PFFSSM, call your group benefits representative first to determine if you need this coverage.
To Complete an Enrollment Form We Sent You
If you received an enrollment form in the mail from us, please fill it out completely. Be sure to check which plan you want to enroll in and to 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 Web site.
Medicare Plus Blue PFFSSM is a health plan with a Medicare contract.
Medicare Plus Blue PFFSSM is available to all Medicare beneficiaries who are Michigan residents entitled to Part A of Medicare and enrolled in Part B. Premiums vary by county. You must continue to pay your Medicare Part B premium.
A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma. You can also read more about how private fee-for-service plans work for you in our downloadable flyer (PDF 160K).
In Michigan, 86 percent of pharmacies are network pharmacies; nationwide, more than 80 percent of pharmacies are in the network, including the majority of chain pharmacies, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies (Source: 2010 Pharmacy Directory). In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Medicare Plus Blue PFFSSM. For additional information on network pharmacies, please call Customer Service at 1-877-469-2583, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704. You may also write to: Medicare Plus Blue PFFSSM, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.
If you decide to have your Medicare Plus Blue PFFSSM premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact Blue Cross Blue Shield of Michigan for details.
In addition to enrolling through this Web site, Medicare beneficiaries may enroll in Medicare Plus Blue PFFSSM through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at medicare.gov. For more information, please contact Medicare Plus Blue PFFSSM at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may only enroll in Medicare Plus Blue PFFSSM during specific times of the year. To learn more about enrollment periods, please contact Customer Service.
This document is available in alternate formats or languages. For more information, call 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704.
Medicare Plus Blue PFFSSM is issued by Blue Cross Blue Shield of Michigan, which contracts with the federal government. Medicare Plus Blue PFFS'sSM contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week;
The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
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