Derived from a Blue Cross® Blue Shield® of Michigan and Blue Care Network
Marketing Communications Alert

Individual Business
Change of Status Form

March 17, 2008

A new process was developed just for valued MyBlue agents. BCBSM has created a change of status form specifically for agents to use when assisting clients in managing their MyBlue contract with BCBSM.

The form will allow you to request effective date changes in order to close a lapse in coverage or to obtain future effective dates, general maintenance changes like address, phone number or name, product changes and contract termination requests. Also attached is a guideline document and continuous enrollment chart to assist in determining the effective date of some product changes.

The billing department has created a special mail box just for agents use and we have a commitment from their team to always process your requests with priority.

Effective today, Monday, March 17th, you can begin sending change of status requests to the following e-mail address or HCA can send them on your behalf:

IBUAgentMembershipRequests@bcbsm.com

or you can fax to 866-392-7528. Please allow 5-7 days for processing.   

Should you have any questions, please do not hesitate to contact an HCA Agent Consultant at (800) 828-1HCA (1422).

HEALTH CARE ADMINISTRATORS, INC.
39500 High Pointe Blvd., Suite 400  Novi, Michigan 48375   www.hcaweb.net
Phone: (800) 828-1HCA (1422)  Fax: (248) 675-4522

Health Care Administrators, Inc. is an authorized independent managing agent for Blue Cross Blue Shield of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are non-profit corporations and independent licensees of the Blue Cross and Blue Shield Association.

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