Enroll Now

• 2008 MedicareBlue PPO Enrollment Form
• 2008 MedicareBlue Rx Enrollment Form
• 2008 MedicareBlue PPO Plan Change Form
• 2008 MedicareBlue Rx Plan Change Form
• When to Enroll

MedicareBlue Rx

A few quick tips before changing plan options...

• You must complete each section before moving to the next one.
• Your change will not be saved until you click the Enroll Now button at the end of the application. If you click Exit Enrollment at any time and come back later, you will need to start over.
• If you have problems changing plan options online you can also:
• Print and mail in the MedicareBlue Rx paper change form (PDF) or
• Enroll by phone by calling 1-866-434-2037, 8 a.m. to 8 p.m., daily, Central and Mountain Time. TTY/TDD users should call 1-866-456-1550.
• If anyone helps you fill out your application, that individual must electronically sign the enrollment form by entering his/her name in the Authorized Representative area and indicate his/her relationship to you.
• No premium payment is required at the time you join. If you complete a paper application, make a copy of your signed application for your records.

After You Change Options

MedicareBlue Rx will send you an acknowledgement letter confirming your plan option change, a new ID card and the plan’s Evidence of Coverage that provides a full description of MedicareBlue Rx benefits.