Blue Care Network Physician Selection Form for Individual Plans

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you're enrolling in a Blue Care Network individual or family plan, use this form to choose your primary care physician.

Access the form here: Physician Selection 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. Each form includes instructions on where to send it.

You can also do this online by logging in to your account at See How can I choose or change my primary care physician online for more information.

If you have any questions, please contact us.

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