• How can I enroll in Medicare Blue PPO?
• Who is eligible to enroll?
• Enrollment Periods

How can I enroll in Medicare Blue PPO?

We offer three easy ways to enroll in Medicare Blue PPO:

1. Enroll online now
2. Phone: Call 1-866-303-2583, Monday - Friday, 8 a.m. - 5 p.m. CST. For the hearing or speech impaired, please call 1-800-722-0353.
3. Mail: Download the enrollment form (PDF), complete and mail in to the address below:

   Medicare Blue PPO
   PO Box 3327
   Tulsa, OK 74101-9917

Our plan is offered by HCSC Insurance Service Company, a Medicare Advantage Preferred Provider Organization (PPO) plan. The attached Summary of Benefits and Enrollment Guide highlight features of our plan. It does not list every service that we cover or list every limitation or exclusion. To obtain a complete list of benefits, you may download the Evidence of Coverage.

• MedicareBlue PPO with Rx Evidence of Coverage
• MedicareBlue PPO without Rx Evidence of Coverage

• Enrollment Brochure (PDF, 384KB)
• Summary of Benefits (PDF, 191KB)

Make paying your premiums easy!
Download, complete and sign the Automatic Premium Payment Program Form (PDF, 162KB). You can even send it in with your application.

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Who is eligible to enroll?

You must be entitled to Medicare under Part A and enrolled in Part B and live in Canadian, Cleveland, Creek, Delaware, Grady, Lincoln, Logan, Mayes, McClain, Muskogee, Oklahoma, Okmulgee, Osage, Pawnee, Payne, Pottawatomie, Rogers, Sequoyah, Tulsa, Wagoner and Washington counties in Oklahoma. You must also maintain your Medicare Part A and Part B coverage by paying monthly Part B premiums, and if applicable, Part A premiums, if not otherwise paid for under Medicaid or another third party.

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Enrollment Periods

 If you are eligible for Medicare Blue PPO, you can enroll during any one of the following three enrollment periods:

Initial Enrollment Period (IEP)
This is a seven (7) month period consiting of:

• three (3) months before the month of your 65th birthday
• the month of your 65th birthday
• three (3) months after the month of your 65th birthday

  Those who are under age 65 and have a disability may also be eligible to enroll.

Annual Enrollment Period (AEP)
You can enroll in Medicare Blue PPO between November 15 and December 31, which is commonly referred to as the Annual Enrollment Period. If you are enrolled in another Medicare Advantage plan, you may also switch to Medicare Blue PPO during this period.

Special Enrollment Period (SEP)
You may also enroll in Medicare Blue PPO outside of the initial or annual enrollment periods under circumstances such as (but not limited to):

• moving into the service area
• involuntarily losing creditable coverage
• becoming dual eligible
  

Because documentation is required to enroll during this period, please contact our Customer Service Department for specific details at 1-800-642-8065, 8 a.m. to 5 p.m., CST. For the hearing or speech impaired, please call 1-800-722-0353.

If you choose not to enroll during these required time frames, the federal government may impose a late enrollment penalty of 1% per month for every month you delay enrollment. To learn more about the late enrollment penalty, please call our Customer Service Department for specific details at 1-800-642-8065, 8 a.m. to 5 p.m. CST. For the hearing or speech impaired, please call 1-800-722-0353.

Alternate formats of this material, including translation, may be available. Please contact Customer Service, at 1-800-642-8065, Monday-Sunday, 8 a.m. - 8 p.m. CST, for additional information. For the hearing or speech impaired, please call 1-800-722-0353.