Blue Care Network Individual Member Change of Status Form
We want you to receive all the Blue Care Network benefits you are entitled to, so it is important to keep your records accurate.
If you're an individual health care plan member (you don't get your health insurance through an employer), use this form to tell us about:
If you have any questions, call the Customer Service number on the back of your enrollee ID card.
Access the form here: Blue Care Network Individual Member Change of Status form (PDF)
Complete the form and return it to us within 30 days of the change. Then mail or fax the form to:
Membership and Billing – Mail Code C411
Blue Care Network
P.O. Box 5043
Southfield, MI 48086