Enrollment For The Medicare Part D Drug Plans Has Ended

Blue Cross Blue Shield MedicareBlueRx Iowa Medicare Part D Drug Plans
(IOWA RESIDENTS ONLY)

  • Optional Electronic Funds Transfer Form -
    (If you wish to have premiums automatically withdrawn from a bank account you must include this form)

    Open Enrollment Ends May 15, 2006

Apply for Coverage

You May Download an Application
If you meet the basic eligibility requirements, you may download the application. The form will open in a new browser window. You may, print it, complete it, and mail it to PO BOX 7018 Lawrence, KS 66044.

Download the most current version of Adobe Acrobat Reader for free: 

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Completing your Application
Some quick tips:

  • If you need help completing the BlueRx application form, or if you have any questions concerning MedicareBlue Rx, just call our toll-free number at 1-800-593-2235.
  • Note: No premium payment is required at the time you join. Make a copy of your signed application for your records.

Premium Payment Option
You may have the monthly premium for this Medicare plan automatically deducted from your Social Security check. If you don’t choose this option, MedicareBlue Rx will send you a bill each month which you can pay by mail or by Electronic Funds Transfer (EFT). Generally, you must stay with the option you choose for the rest of the year.

You may choose to download the Electronic Funds Transfer form now, print it, and mail it to the address on the form

Serviced by www.iowahealthinsurance.biz & MultiQuote Insurance www.mqins.com
 

MultiQuote Insurance LLC * 1237 Avenue H  Fort Madison, IA 52627 *
Phone: 319-372-8860 or 800-593-2235 * Fax: 319-208-0215