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.

Do you need a new ID card?

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

Forms

  • Change Plan 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.
  • Appointment of Representative Form
    Michigan Medicare members can use this form to choose a representative for their medical decisions. Download it here.

Documents

  • 2019 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.
  • Pharmacy Directory
    If you have prescription drug coverage through your Medicare plan, read this article for tips on finding a pharmacy.
  • 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 your 2018 book 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.

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