After You Enroll in Blue MedicareRxSM


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After receiving your completed enrollment form, Blue MedicareRx will send you:

  • An acknowledgement letter within 10 days of receiving your enrollment form
  • After your enrollment has been approved, we'll send you a confirmation letter no later than ten (10) calendar days from receipt of CMS's confirmation of enrollment. This letter will include your ID card.
  • You will receive a Welcome Kit approximately two weeks after the ID card and confirmation letter. This package will include your Evidence of Coverage along with everything you'll need to know about being a member of Blue MedicareRx

Evidence of Coverage

The Evidence of Coverage (EOC) is a detailed document that explains the plan rules associated with Blue MedicareRx. This document, together with your enrollment form, riders, coverage and the amendments that we may send to you, is our contract with you.

The EOC explains:

  • What is and is not covered by Blue MedicareRx
  • How to get your prescriptions filled
  • What you will have to pay for your prescriptions
  • Your rights and responsibilities

Evidence of Coverage: Value Plan  
S5715_BEN_IL_ANOCEOCVALUE2012 File and Use 09022011

Evidence of Coverage: Plus Plan  
S5715_BEN_IL_ANOCEOCPLS2012 File and Use 08302011

Evidence of Coverage: Value Plan en Español
S5715_BEN_IL_ANOCEOCVALUE2012SPA File and Use 09022011

Evidence of Coverage: Plus Plan en Español
S5715_BEN_IL_ANOCEOCPLS2012SPA File and Use 08302011

Your Protections in this Plan

Blue MedicareRx agrees to stay in the program for a full year at a time. Each year, the plan decides whether or not to continue offering prescription drug coverage for the following year. Should we decide not to continue offering Blue MedicareRx, we will send you a letter explaining your options for Medicare prescription drug coverage in your area. Your Medicare coverage is not affected.

As for claims, if Blue MedicareRx ever denies your prescription drug benefits, we will explain our decision to you. You always have the right to appeal and ask us to review the claim that was denied. In addition, if your physician prescribes a drug that is not on our formulary, is not a preferred drug, or is subject to additional utilization rules, you may ask us to make a coverage exception.

Guidelines for Disenrollment

Disenrollment from Blue MedicareRx means ending your membership. Disenrollment can be voluntary or involuntary. We are not allowed to ask you to leave the Plan because of your health.

Voluntary Disenrollment

You can leave the Plan and join another Medicare prescription drug plan, Medicare Cost Plan, or Advantage Plan available in your area. It will take some time for your prescription drug coverage to end and your new prescription drug coverage to begin.

To voluntarily disenroll:

  • You must choose to leave the Plan.
  • You must provide a signed written notice to Blue MedicareRx through your employer (if applicable).
  • Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. If you are hearing or speech impaired, please call 1-877-486-2048.

Involuntary Disenrollment

HCSC Insurance Services Company (HISC) must disenroll an individual from Blue MedicareRx in the following cases:

  • The individual moves out of the plan's service area and becomes ineligible to be an enrollee of Blue MedicareRx.
  • The individual loses entitlement to Medicare.
  • The individual dies.
  • The Blue MedicareRx contract is terminated or Blue Cross and Blue Shield of Illinois discontinues offering Blue MedicareRx in any portion of the area where it had previously been available.
  • The individual materially misrepresents information to HISC regarding reimbursement for third-party coverage.

Need Assistance?


Blue MedicareRx

Call 1-877-213-1821


This information is available for free in other languages. Please contact our Customer Service number at 1-877-213-1821 for additional information. (TTY/TDD users should call 711). Hours are 8 a.m. - 8 p.m., local time, 7 days a week. From February 15th through October 14th alternate technologies (for example, voicemail) will be used on the weekends and holidays. Customer Service also has free language interpreter services available for non-English speakers. en Español

Contact us: Blue MedicareRx
                      P.O. Box 3897
                      Scranton, PA 18505-9947