Thanks for choosing Blue Medicare HMO. We'll walk you through the steps to enroll online. There are five steps and it should take no more than 30 minutes to complete. We recommend you complete the enrollment form in one sitting, as this session will expire after 30 minutes of inactivity. When you complete this process, you're submitting an actual enrollment form for enrollment in a Blue Medicare HMO plan. Important: If you have health coverage currently, joining a Blue Medicare HMO plan could affect your benefits or change how your current coverage works. Your privacy is important to us. We're committed to protecting customer privacy on our website. We've taken steps to protect information collected from online customers against unauthorized access and use. For more information, view our privacy policy.

STEP 1 of 5: Enrollment Information

Enrollment/Retiree eligibility status approved:        Employer Group Name: Novant Health   Group Number:

®, ^SM Marks of the Blue Cross and Blue Shield Association.
Y0079_6360 EGW

® SM Marks of the Blue Cross and Blue Shield Association. An independent licensee of the Blue Cross and Blue Shield Association.

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