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Plan65 Information Request Form

Blue Cross and Blue Shield of Oklahoma will send you a packet of information about Plan65.

Look over the materials and decide which Medicare supplement plan best suits your needs.

What to do:

Simply complete the form below, and a Plan65 informational packet will be sent to you shortly.

Your information:                                    *Required Information

* Name:    

* Address:

  

* City:

 

* State:

  * Zip:

* Phone number:

 

* Age:

        

*Date of Birth:
(mm/dd/yyyy)

* E-mail address:

* Do you currently have another Medicare supplement plan? Yes No

If yes, which company?

* Are you currently a Blue Cross and Blue Shield of Oklahoma member? Yes No

You may apply for Plan65 coverage if:

  • You have Medicare Part A and B and;
  • You are an Oklahoma resident and;
  • You are age 65 or older.
   

   
 

Need Assistance?


Medicare Supplement:

Sales:

1-866-303-2583

Mon-Fri 8:00 am - 8:00 pm CT
Sat 8:00 am - 6:00 pm CT
Sun 10:00 am - 6:00 pm CT

Customer Service:

1-800-722-3959