Please provide the following information to request a visit from one of our marketing representatives in the comfort of your own home.
By giving Independence Blue Cross your email address or telephone number, you agree to allow Independence Blue Cross to contact you with information related to its health benefits plans, products, services and/or educational information related to health care. By entering your mobile phone number, you are agreeing to receive a telephone call using an Automated Telephone Dialer System. We will make every effort to contact you within 24 hours. However, please be aware that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail.
The person that will be discussing plan options with you is either employed or contracted by a Medicare health plan or prescription drug plan that is not the Federal government, and they may be compensated based on your enrollment in a plan.
Signing this does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan.
To ensure your privacy, all information will be sent via a secure connection. Independence Blue Cross will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law.
Please see our Notice of Privacy Practices for more information.
Website last updated: 10/1/2015
Y0041_HM_17_43499 Approved 10/7/2016
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.