Online Requests and Reservations - Banner

Medicare Advantage Information Request

Thank you for your interest in Medicare Advantage information from BlueCross BlueShield of Western New York.
Submit Your Request Online: Please complete the information below and we will mail the information requested to the address you provide.

Or Call Us: Make your request or ask questions by calling 1-800-248-9296 (TTY 1-877-286-5710 for hearing impaired).  We are available: 

  October 1 - February 14   8 a.m. to 8 p.m., 7 days a week
  February 15 - September 30   8 a.m. to 8 p.m., Monday - Friday




During non-business hours, your call will be answered by our automated phone system.  A Customer Service Representative will return your call on the next business day. 

By replying to this online request, a sales person may call you.

Provided by
BlueCross BlueShield of Western New York

Your Information   * Required

First Name *
Last Name *
Address *
City *
State/Province *
Zip Code *
Home Phone
Email (for confirmation & notifications)
May we follow up with you by phone? *
May we contact you by email? *
Yes to send me a website address I requested
Yes to answer my questions
County of residence?
How did you hear about us?
If DM-Direct Mail, what was the code on the mailer?
I am interested in getting information because I am:
Please send information on the following (you may check more than one): *
2013 Senior Blue HMO/Forever Blue Medicare PPO
2013 BlueSaver MSA/Medigap/BlueCross BlueShield Rx PDP
2013 BlueCross BlueShield Rx PDP
Choose format of requested information: *
Current health insurance company?
When you choose a healthcare plan, what affects your decision the most?

 I authorize you to contact me either by phone or e-mail if this request is missing any information.

Online Requests and Reservations - Banner