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.

E-mail Security

Since e-mail is not a secure form of communication, we are unable to answer the following types of questions by e-mail:

  • 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*:
ZIP*: - (#####-####)
Phone*: (###-###-####)
E-mail:  
Date of Birth*: (mm/dd/yyyy)

Medicare Prescription Drug Plan 2008


 

Medicare Supplemental insurance is available from the following affiliated companies:

CareFirst BlueCross BlueShield



 

Blue Cross Blue Shield of Delaware

 

What is your preferred way to receive product information?

Mail
E-mail with PDF attachment
Fax (please provide fax # )

Questions and comments:

(Please read e-mail security statement)
 

Yes! I would like to receive information from CareFirst BlueCross BlueShield about insurance products available in my area via e-mail.

    
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