How To Enroll

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Enroll Online Now!

Follow These Instructions to Enroll (you will need to have your Medicare ID card available):

• Print the Enrollment Form (PDF)
• Complete the Personal Information and Medicare Information sections. Please print clearly.
• Select the plan in which you wish to enroll by checking the box to the left of the plan name.
• Select your method of payment. No payment is required with your enrollment form.
• Answer the questions on the enrollment form. 
• Carefully read the rest of the enrollment form, sign and date it.
• Please make a copy of the form for your records.
• Mail to the address below:
  

  BlueCross BlueShield of Tennessee
  Medicare Sales
  P.O. Box. 180205
  Chattanooga, TN 37402

  Or Fax to:
  (423) 296- 4582

When Will Your Coverage Become Effective?

For Current Medicare Beneficiaries (d):

• If you enroll during the Annual Coordinated Election Period, your coverage will begin on Jan. 1 of next year.

For New Medicare Beneficiaries:

• If your enrollment form is received within the three months prior to the month you become eligible, your coverage will begin on the first day of the month you become eligible for Medicare.
• If your enrollment form is received during the month you become eligible or the following three months, your coverage will become effective the first day of the next month after your enrollment form has been received.

For Enrollment During Open or Special Enrollment Periods

• Your coverage will become effective the first day of the month after your enrollment form has been received.

Note: We recommend that you submit your enrollment form as early in the month as possible. By doing so, you are more likely to have your BlueAdvantage PFFS ID card in time for easy access to your benefits when your coverage begins.