Contact Us - Medicare D
Contact Us
Request an Information Kit
If you would like to receive more information about coverage for individuals and families, or if you have any questions about these products, please fill out the form below and click the "send" button.
Email Security
Since email is not a secure form of communication, we are unable to answer the following types of questions by email
:
Questions about your medical condition or your treatment plan
. Please contact your primary care physician if you have medical questions.
Questions that require sending confidential information
.
(Social Security Number, medical information, benefit information, mental health)
Please call the Member Services number on your ID card with all benefit and claim questions.
*
Required
General Information
*
First Name:
M.I.
*
Last Name:
*
Street Address:
Street Address 2:
*
City:
*
State:
---Select your state----
Maryland
Delaware
District of Columbia
Virginia
*
ZIP (#####-####):
-
*
Phone (###-###-####):
E-mail:
*
Date of Birth:
(mm/dd/yyyy)
*
Is this person eligible for Medicare?
Yes
No
Send Me More Information About:
(Products are available for selection based on ZIPcode entered)
Medicare Prescription Drug Plan 2009
Blue Rx (MD, DC,
DE
)
Blue MedicareRx (
VA
)
Medicare Supplemental insurance is available from the following
affiliated companies.
CareFirst BlueCross BlueShield
Medicare Supplement Plans
Medigap-65 MD
Supplement-65 DC
Supplement-65
VA
Blue Cross Blue Shield of Delaware
Medicare Supplement Plans
Delaware Medigap-65
Questions and comments:
(Please read
email security statement
)
Yes! I would like to receive information from CareFirst BlueCross BlueShield
about insurance products available in my area via e-mail.
