Apply online - it's virtually paperless and takes only minutes to complete!
Or you can download, print and fill out the Blue Medicare Rx Plan enrollment form (PDF).
Complete all sections of the form following the instructions outlined on the form.
Mail the completed form to the following address:
P.O. Box 17168
Winston-Salem, NC 27116
You should receive your membership information and your BCBSNC ID card in about 10 to 14 days after your application has been received.
If you need assistance filling out the application, please call an authorized agent toll free at 1-800-478-0583, 7 days a week, from 8:00 a.m. to 8:00 p.m.
For more information, you can download and print the following documents for future reference:
Individuals with limited income and resources may qualify for extra help. Learn more about financial assistance, and get answers to other common questions, in our frequently asked questions.
Learn more about Dental Blue.
To view PDF documents you need Adobe Acrobat Reader.
BCBSNC is a prescription drug plan sponsor with a Medicare contract. Prescription drug coverage is not sold as a benefit of any Medicare supplement plan.
For Medicare Advantage and Part D plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. For Medicare supplement plans, the changes occur on June 1 of each year. Please contact BCBSNC for details.
BCBSNC is a Medicare Advantage organization with a Medicare contract. BCBSNC is a Medicare-approved Part D sponsor. BCBSNC does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All BCBSNC items and services are available to all eligible beneficiaries in the service area. Limitations, copayments, and restrictions may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in CMS-approved service area. You must continue to pay your Medicare Part B premium.
If you would like Medicare Advantage or Part D documents in a different language or format, or your coverage has ended and you need proof of coverage or a Certification of Health Insurance Coverage, you can call us 7 days a week, 8 a.m. to 8 p.m.
The information on this page is current as of 10/01/2012.
Y0079_5875 CMS Approved 10012012