Get Application For Coverage With Health History

The Application For Coverage With Health History is essential for those seeking Medicare Supplement or Medicare Select policies. This guide provides clear, step-by-step instructions to help users fill out the form effectively and efficiently.

Follow the steps to complete your application accurately.

1. Use the ‘Get Form’ button to obtain the application form and open it in your preferred editor.
2. Complete Section I: Provide personal details such as your name, home address, contact number, birth date, and social security number accurately.
3. Make sure to check if you are enrolled in both Medicare Part A and Part B. Attach a copy of your Medicare ID card to your application.
4. Fill out the necessary health history questions in Section II to the best of your knowledge. Be prepared to disclose any pre-existing conditions or treatments.
5. In Section III, indicate your tobacco use and answer other specific health-related questions. If you are eligible for guaranteed issue, be aware that you may skip this section.
6. Select the Medicare plan you wish to apply for in Section II and specify your preferred payment method in Section I, item #10.
7. Sign and date your application to certify that all information provided is complete and accurate. Retain a copy for your records.
8. Submit your application to Blue Cross and Blue Shield of Minnesota. Allow 3-6 weeks for processing, during which you will receive your member identification card.

Complete your application for coverage online today to ensure your health needs are met.