MedicareBlue Rx 2018 Change Form

Call Center Agents

Call center agents must obtain enrollment consent and permission to record the enrollment.

  • Can you please confirm that the purpose of your telephone call today is to enroll in MedicareBlue Rx, a Medicare prescription drug plan?
  • The enrollment process will take about 10 to 15 minutes.
    • You’ll need to have your Medicare card available so that we can verify some information.
      At any time during this call, you may stop the enrollment process without obligation.
      All information that you provide to us is private and strictly confidential.
      Per Medicare guidelines this enrollment will be recorded.
  • Do you give your permission to record this enrollment?
  • Please be aware we can only enroll one person at a time.
  • Do you have any questions before we go on?


A few quick tips before enrolling...

  • Please read this important information.
  • Make sure you meet the eligibility requirements.
  • Please review the Summary of Benefits, and Star Ratings.
  • You must complete each section before moving to the next one.
  • Your enrollment will not be saved until you click the Enroll Now button at the end of the application.
  • If you have problems enrolling online you can also:
  • If anyone helps you fill out your application, that individual must electronically sign the enrollment form and indicate his or 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’ve enrolled

We’ll send you a letter confirming your enrollment and a member ID card. You’ll also receive a letter from us to verify your enrollment if you were assisted in your enrollment by an agent. The letter will describe how the plan works and provide a phone number for you to call if you have additional questions. You’ll receive a welcome kit that includes an Evidence of Coverage (a full description of MedicareBlue Rx) benefits.

Note: Do not disenroll from any other drug plan you may have until you receive approval from MedicareBlue Rx.