Change Your Plan Forms

Who is this for?

If you want to change your plan or add dental and vision coverage to your BCN AdvantageSM or Medicare Plus Blue PPO plan, these forms will help.

There are some rules for changing your Medicare health coverage. It's a little different for each kind of plan. So make sure to read everything carefully before filling out a form.

Note: If you're a Blue Cross® Medicare Private Fee for Service member and you want to change your plan, please call the Customer Service number on the back of your Blue Cross ID card and we'll help.