Change of Status Form
For Blue Cross Blue Shield of Michigan PPO members with individual health plans
Who is this for?
If you’re a Blue Cross Blue Shield of Michigan PPO member and you have an individual health plan, use this form to let us know if your name, address or family size changes.
We want you to receive all the benefits you’re entitled to, so it's important to keep your records accurate. Let us know any time your name, address or family size changes. You may also hear these types of changes referred to as qualifying life events.
You can also use this form for coverage changes. If you have a qualifying life event, you can change your health plan. Or, if your plan's eligible, you can use this form to add a health savings account.
Access the form here: Change of status form for PPO individual health plans (PDF)
What you’ll need:
- Your enrollee ID card
- A printer to print the form
- Supporting legal documentation (if required)
- An envelope and postage to mail the form, or a fax machine
Complete the form and return it to us within 60 days of the change. You can mail or fax the form to:
|Blue Cross Blue Shield of Michigan
P.O. Box 44407
Detroit MI 48244-0407
If you have any questions, call the Customer Service number on the back of your Blues ID card, and we'll help.