Preferred Maketing Associates (PMA)
Monday - Thursday:
8 am - 4:45 pm
8 am - 12:30 pm
            BCBS Med Supp App   (2297 kb)
            2021 BCBS Med Supp App - For Effective Dates 1/1/21 and Later  (313 kb)
            BCBS Med Supp Household Discount Guidelines 1-1-2019  (13 kb)
            BCBS Outline of Coverage (Rates) April 1, 2020 to March 31, 2021  (1692 kb)
The AOR form must be submitted with an underwritten application.
            BCBS Med Supp AOR Form   (79 kb)
            BCBS Med Supp Debit Auth Form   (714 kb)
            BCBS (EMPLOYER) Med Supp Debit Auth Form   (557 kb)
BCBS Dental Essentials Brochure - Rates
            BCBS Dental Essentials Brochure - Rates   (846 kb)
            Stand-alone Dental Application  (703 kb)
      Please submit with all Medicare Supplement Applications
            Medicare Card Form  (32 kb)
            2020 Medicare & You   (3425 kb)
            2020 Choosing a Medigap Policy  (795 kb)
            Medicare Supplement Replacement Form  (42 kb)
            A Guide to Your Premium Payments  (162 kb)
      This form is used for Medicare Supplement or Over 65 Dental plans ONLY.
            Bank Account or Address Change Form  (202 kb)
            Effective Date Form  (32 kb)
            Cancellation Form  (74 kb)
            PHI Release Form  (145 kb)
            BCBS Reinstatement Form   (702 kb)
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