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Forms and Documents

Are you looking for your plan’s drug list? Do you want to sign up for automatic billing? While we like to make most things easy to manage online, there are some things you'll need to send to us by mail. And sometimes it's nice to be able to print out important plan information. Here's where you'll find your plan's documents and forms.

Blue Cross Blue Shield of Michigan Blue Care Network member ID card

Do you need a new ID card?

If your Blues ID card is lost, damaged or stolen, find out what you need to do to order a new card.

Forms

  • Account Management Forms
    These forms will be helpful if you need to change your Michigan Medicare plan or add dental and vision coverage to your BCN Advantage plan.
  • Pharmacy Forms
    These forms will help you manage your prescription drug coverage.
  • Payment Forms
    Use this form to have your Medicare Advantage or Part D plan premiums taken out of your bank account.
  • Claim Forms
    Use these forms to ask us to pay you back for medical expenses, like prescriptions or out-of-network doctors costs.
  • Enrollment Forms
    Find enrollment forms for our Medicare Advantage, Medigap and PDP plans here.
  • Member Rewards Forms
    Want to claim member rewards? Fill out these health evaluation, glaucoma, mammogram and diabetes testing forms.
  • Grievances and Appeals Forms
    Do you need to file a complaint or coverage determination for your Michigan Medicare plan? Fill out these forms, and we'll contact you to help.
  • Appointment of Representative Form
    Michigan Medicare members can use this form to choose a representative for their medical decisions. Download it here.

Documents

  • Drug Lists and Formularies
    Need to know if your Medicare plan covers a specific prescription drug? You can use the drug list, also called a formulary, to find out.
  • Provider Directories
    Are you looking for a list of doctors, hospitals and specialists that accept Medicare patients? Use these directories.
  • Summary of Benefits
    You can use this document to compare it to other plans and see key features, including cost, benefits, deductibles, copays.
  • Evidence of Coverage
    Your evidence of coverage book is like an instruction manual for your Michigan Medicare Advantage plan. Find yours here.
  • Health Plan Ratings
    Want to know which Michigan Medicare plans have the best quality? See government ratings to find out which coverage might be best for you.
  • Service Area Maps
    Want to know where you can get Medicare coverage in Michigan? These service area maps can help.
  • Low-Income Subsidy Premium Charts
    Learn more about the monthly LIS premiums for Michigan Medicare plans.

Related Medicare 101 items

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Page Last Updated Fri Jul 11 11:44:24 EDT 2014