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View 2009 RxBLUE benefits
Information Request Form

To request more information about why RxBLUE (PDP) should be your choice for your Medicare Prescription Drug Plan, fill out the form below or call us now! You can contact an RxBLUE (PDP) representative 24 hours a day, seven days a week at 1.800.593.9735.

Our Organization contracts with the Federal government. RxBLUE (PDP) is a stand-alone prescription drug plan with a Medicare contract.

Pending CMS Approval

 

RxBlue Information Request Form

* Required Fields
First Name:*
Last Name:*
Phone Number:*
Preferred Contact Time:Morning   Afterrnoon   Evening
Address:*
City:*
State:*
Zip Code:*
 
 I would like to receive e-mail from RxBLUE.
E-mail Address:
 
This is not an application for insurance.
 
By submitting this form, you are giving your consent to have a Blue Cross and Blue Shield of Louisiana licensed and appointed agent contact you about RxBLUE. Your name will NOT be added to a mailing list and there is NO obligation to buy.
     

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