Get Medicare Select Application - Blue Cross And Blue Shield Of South ...

This guide provides comprehensive instructions for users on how to fill out the Medicare Select Application online. Follow these steps to ensure the process is clear, supportive, and accessible for all individuals seeking to apply.

Follow the steps to successfully complete your application.

1. Use the ‘Get Form’ button to access the Medicare Select Application form. This allows you to start filling out the document online.
2. Begin with Part I, which asks for general information. Enter your printed name, address (both residence and mailing if different), birth date, age, gender, and social security number. Additional details such as your home phone number and email address should also be filled out accurately.
3. Indicate which Medicare plan you are applying for. This typically includes selecting the Medicare Select Plan option.
4. In the Medicare Insurance Information section, fill out details from your Medicare card, including your name, Medicare claim number, and effective dates for Medicare Part A and Part B.
5. Provide billing information preferences, selecting either monthly bank draft, monthly billing, or monthly credit card billing. If choosing bank draft or credit card, complete the authorization agreement on the designated page.
6. In Part II, answer health and medical questions. Be honest about your medical history, providing all required details in the space provided. This section is crucial for your application evaluation.
7. Complete Part III by providing information on any existing coverage. Answer questions regarding previous and current Medicare plans, including the intention to replace any existing policies.
8. Read the important statements in Part IV carefully. This section includes consumer protection information and an authorization section. Ensure you understand the terms before signing.
9. Sign and date the application. Ensure all information is complete and accurate before submitting.
10. Finally, after filling out the form, you can save your changes and download, print, or share the completed application as needed.

Start competing your Medicare Select Application online today for a smoother process.