Non-Group Membership Changes

Changes Allowed Anytime

If you have existing non-group coverage you may make the following membership changes at anytime:

• name
• address
• add dependents
• remove dependents

NOTE:  Members with group coverage should contact their benefits manager to request a change.

Requesting A Change

To request a change, complete the appropriate form:

Members of...	Should complete...	And Submit to...
A Non-Group Health Plan   - VFP  - HSA BlueCare	Non-Group application/change form	BCBSVT Account Services P.O. Box 186 Montpelier, VT 05601-0186
Catamount Bluesm	Catamount application/change form	BCBSVT P.O. Box 186 Montpelier, VT 05601-0186

NOTE:  Please send changes & subscription payments separately; they're processed in different locations.

We Can Help, Give Us A Call

If you have questions or need help completing the form, call:

• 800-625-6406 (non Catamount Blue^sm members)
• 888-445-5805 (Catamount Blue^sm members)