Enroll in a Blue Cross dental or vision plan

To purchase an individual and family dental or vision plan complete the enrollment form below and provide all required documents. You must be a Minnesota resident over the age of 18 or have a parent or guardian listed as a contract holder to enroll in a plan.

For help completing the enrollment form call 1-800-531-6685 (TTY 771) or schedule an appointment with a Blue Cross Advisor.

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Qhia peb txoj koj tus kheej

I am a new applicant: *

I am currently enrolled in a Blue Cross Dental or Vision individual plan: *

Thov nco tseg: Tej zaum yuav qeeb rau Kev Saib Xyuas Koj Daim Ntawv Thov yog tias daim foos no ua tsis tiav hauv nws txhua yam.

Thaum koj suav nrog cov naj npawb Xaus Saus (SSNs) peb tuaj yeem nqis tes ua koj Daim Ntawv Thov kom muaj txiaj ntsig ntau ntxiv, tab sis koj tsis tas yuav tsum suav nrog cov no rau koj cov neeg nyob nrog los sis koj tus kheej.

Qhov Chaw Nyob Hauv Tsev Ruaj Chaw (Npawb PO Box #)
 
Chaw Nyob Xa Ntawv (Yog tias sib txawv ntawm chaw nyob hauv tsev)
 
Chaw Nyob Sau Nqi (Yog tias sib txawv ntawm chaw nyob hauv tsev ruaj chaw thiab chaw nyob xa ntawv)
 
 

I have been a permanent resident of Minnesota for a minimum of 183 days *
Important: Peb tsuas yog tuaj yeem muab kev duav roos rau cov neeg nyob ruaj chaw hauv Minnesota xwb.  

Will you or any other enrollee receive any premium or cost-sharing payments made by a specific person or entity, directly or indirectly, by any ineligible third party? *  

Ethnic Background:  

Race (Select one or more):  

Spoken Language:  

Written Language:  

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Leej twg yuav nyob hauv qhov phiaj xwm?

Qhia peb txog txhua tus neeg uas tab tom thov rau kev raug pov thaiv.

Tus Neeg Nyob Hauv Kev Saib Xyuas 1

Tus neeg no puas nyob ua ke rau tib qhov chaw nrog koj?

Yog Tias Tsis Yog, sau cov npe chaw nyob:

Ethnic Background:  

Race (Select one or more):  

Tus Neeg Nyob Hauv Kev Saib Xyuas 2

Tus neeg no puas nyob ua ke rau tib qhov chaw nrog koj?

Yog Tias Tsis Yog, sau cov npe chaw nyob:

Ethnic Background:  

Race (Select one or more):  

Tus Neeg Nyob Hauv Kev Saib Xyuas 3

Tus neeg no puas nyob ua ke rau tib qhov chaw nrog koj?

Yog Tias Tsis Yog, sau cov npe chaw nyob:

Ethnic Background:  

Race (Select one or more):  

Tus Neeg Nyob Hauv Kev Saib Xyuas 4

Tus neeg no puas nyob ua ke rau tib qhov chaw nrog koj?

Yog Tias Tsis Yog, sau cov npe chaw nyob:

Ethnic Background:  

Race (Select one or more):  

Tus Neeg Nyob Hauv Kev Saib Xyuas 5

Tus neeg no puas nyob ua ke rau tib qhov chaw nrog koj?

Yog Tias Tsis Yog, sau cov npe chaw nyob:

Ethnic Background:  

Race (Select one or more):  

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Xaiv kev duav roos thiab kev them nyiaj

Koj li kev raug pov thaiv yuav pib hauv thawj hnub ntawm lub hli tom qab kev tau txais koj Daim Ntawv Thov uas tau ua tiav tshwj tsis yog koj qhia txog hnub kom pib siv tau uas tau thov sib txawv hauv qab - seb qhov twg yuav yog tom qab. Cov hnub tom kom pib siv tau uas tau thov yuav tsum nyob hauv 90 hnub tom qab kev tau txais koj Daim Ntawv Thov uas tau ua tiav lawm.

Txoj Kev Xaiv Duav Roos Nqi Kho Hniav

Cov Kev Xaiv Qhov Tuab Kom Tuaj Sau Nqi:

Them Cov Nqi Tuav Pov Hwm ($):

Kuv li kev duav roos yuav yog rau:

Hnub Kom Pib Siv Tau Uas Tau Thov:

Yog tias ntxiv ib tus me nyuam nyob nrog sab nraud ntawm kev ntxiv sij hawm tshiab, xaiv qhov laj thawj rau qhov kev ntxiv:

Txoj Kev Xaiv Duav Roos Nqi Kho Qhov Muag

Kev Them Tus Nqi Tuav Pov Hwm Ib Xyoos (Sau Nqi Ib Xyoos Nkaus Xwb) ($):

Kuv Li Kev Raug Pov Thaiv yuav muab cia rau:

Hnub Kom Pib Siv Tau Uas Tau Thov:

Yog tias ntxiv ib tus me nyuam nyob nrog sab nraud ntawm kev ntxiv sij hawm tshiab, xaiv qhov laj thawj rau qhov kev ntxiv:

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Qhov Ntaub Ntawv Txog Kev Tuav Pov Hwm Kho Hniav thiab/los sis Kho Qhov Muag

Yog tias tam sim no koj muaj Blue Cross Tus Kheej/Tsev Neeg txoj cai kho hniav thiab/los sis kho qhov muag, koj txoj cai tam sim no yuav tau txais kev hloov chaw raws li hnub uas pib siv tau ntawm koj txoj phiaj xwm tshiab. Yog tias koj li kev raug pov thaiv tam sim no yog tau los ntawm tus tswv hauj lwm los sis lwm lub chaw muab kev pov hwm, Blue Cross tsis tuaj yeem tshem tawm tau qhov kev raug pov thaiv ntawd rau koj tau.

Have you or any family members applying for a dental plan under this Application had continuous comparable coverage immediately prior to the effective date of the dental plan selected? *

Yog tias koj teb tias Yog, thov muab cov ntaub ntawv txhawb nqa uas muaj npe nram qab no thiab sau cov ntaub ntawv hauv qab no. NCO TSEG: Kev duav roos nqi kho hniav yav tas dhau los yuav raug tshuaj xyuas thiab tej zaum yuav cuam tshuam koj li kev tsim nyog los sis cov txiaj ntsig. Cov ntaub ntawv txhawb nqa yuav tsum tau muab los ua pov thawj kev tsim nyog. Kev txo nqi kev duav roos kho hniav tsis tsim nyog ua qhov kev duav roos sib piv.

Ntaub Ntawv Txhawb Nqa:

  • Tsab ntawv rau lub chaw muab kev pab them nqi kho hniav yav tas dhau los qhia pom txog kev raug duav roos uas tuaj yeem yuav luag zoo ib yam
    • Yuav tsum muaj nyob rau ntawm tsab ntawv ntawm lub chaw muab kev tuav pov hwm raws cai
    • Yuav tsum tau sau tag nrho cov neeg uas tau txais kev duav roos raws li txoj phiaj xwm thiab lawv cov hnub tim duav roos.
  • Cov ntsiab lus ntawm txoj phiaj xwm cov txiaj ntsig

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Cov ntaub ntawv kev ceeb toom thiab kev tso cai

Los ntawm kev ua kom tiav Daim Ntawv Thov kev tso npe, kuv nkag siab tias kuv yuav xa daim ntawv thov tiag-tiag rau kev tso npe thiab kuv pom zoo raws li nqe hauv qab no:

  • Kuv li kev kos npe rau hauv Daim Ntawv Thov no qhia tias kuv tau nyeem thiab nkag siab tag nrho cov nqe lus hauv qab no thaum thov rau kev raug pov thaiv kho hniav/kho qhov muag lawm dhau ntawm Blue Cross and Blue Shield of Minnesota (Blue Cross).
  • Kuv nkag siab thiab pob zoo tias kev raug pov thaiv, yog tias tau txais kev pom zoo, yuav pib muaj raws li tau hais qhia meej hauv nplooj ntawv 4. Kuv tso cai rau Blue Cross los siv qhov ntaub ntawv los ntawm kuv cov tshwv los xa cov peev nyiaj hauv hluav taws xob ua ib zaug ntawm kuv tus as khauj los sis los khiav ntaub ntawv kev them nyiaj thaum muaj kev them nyiaj ntawm tshev. Thaum Blue Cross siv qhov ntaub ntawv hauv kuv daim tshev los xa cov peev nyiaj hauv hluav taws xob, yuav muab cov peev nyiaj rho tawm ntawm kuv tus as khauj sai li sai tau hauv tib hnub uas Blue Cross tau txais kuv daim tshev thiab kuv yauv tsis tau txais kuv daim tshev rov qab los ntawm kuv qhov xwm txheej nyiaj txiag.
  • Kuv nkag siab tias yuav tau txais kev raug pov thaiv raws li daim ntawv cog lus rau ib tug neeg. Kuv nkag siab tias Blue Cross tsis muab kev duav roos rau ib leeg los ntawm tus tswv hauj lwm. Blue Cross tsis lav lees rau qhov kev ua twg uas tau ua los ntawm tus tswv hauj lwm uas ua rau qhov kev raug pov thaiv no tau txais kev xam tias yog kev raug pov thaiv ua pab pawg raws li lub xeev los sis tsoom fwv txoj kev cai lij choj. Tus tswv hauj lwm yuav lav lees ib leeg rau ib qho kev nrhia tau ntawd.
  • Cov hom phiaj kom tau txais qhov ntaub ntawv ntsig txog Daim Ntawv Thov no, rov ua dau, los sis hloov pauv cov txiaj ntsig kev raug pov thaiv, daim ntawv tso cai no siv tau ntev li ntev tau uas thaum twg kuv tseem tau txais kev pab them los ntawm Blue Cross. Kuv muaj cai tau txais ib daim theem ntawm daim ntwav tso cai twg los xij uas kuv kos npe rau.
  • Feem ntau Blue Cross yuav vam khom qhov ntaub ntawv uas tau muab los thiab kev nthuav tawm tag nrho ntawm qhov ntaub ntawv uas tau sau tseg hauv Daim Ntawv Thov no uas muaj kev txiav txim siab seb puas lees txais tus neeg thov thiab/los sis (cov) tus neeg nyob hauv kev saib xyuas tau sau tseg hauv Daim Ntawv Thov no rau kev raug pov thaiv. Kuv paub zoo txog qhov tseem ceeb ntawm kev muab kom tau qhov ntaub ntawv kom raug thiab kom txhij txhua. Kuv paub zoo tias kuv yuav tsum tau teb tag nrho cov nqe lus nug hauv Daim Ntawv Thov, txawm tias kuv thiab/los sis (cov) tus neeg nyob hauv kev saib xyuas uas tau sau tseg hauv Daim Ntawv Thov no twb muaj kev raug pov thaiv tam sim no los sis twb tau muaj kev raug pov thaiv nrog Blue Cross ua ntej los lawm. Kuv nkag siab tias kuv yuav tsum yog tus pej xeem uas nyob ruaj khov hauv xeev Minnesota kom muaj cai tau txais rau qhov kev raug pov thaiv no thiab ntawm no kuv lav lees tias txij li hnub uas pib siv tau ntawm kuv daim ntawv cog lus kuv yeej yog tus pej xeem uas nyob ruaj khov hauv xeev Minnesota thiab muaj cai rau qhov kev raug pov thaiv no. Kuv kuj nkag siab tias yog tias qhov kev lav lees no pom tau tias tsis yog qhov tseeb, Blue Cross yuav tshem tawm kuv daim ntawv cog lus thiab kev raug pov thaiv, thiab yuav tsis them cov kev thov nyiaj rov qab li. Kuv ua pov thawj ntxiv tias kuv tsis raug txhawb los sis qhia kom thov rau qhov kev pab duav roos no nrog rau ib qho kev muab los ntawm ib tus neeg thib peb uas tsis tsim nyog (tau piav qhia ntawm phab 1) kom them ncaj qha los sis tsis ncaj qha rau txhua yam los sis ib txhia ntawm cov nqi tuav pov hwm los sis cov nqi sib koom them.
  • I attest that I was not encouraged or advised to apply for this coverage in connection with any offer by an ineligible third party to directly or indirectly pay all or some of my premiums or cost sharing.
  • Kuv pom zoo ceeb toom rau Blue Cross kiag tam sim txog ib qho kev hloov pauv hauv kuv tus kheej los yog ib tus neeg nyob nrog cov ntaub ntawv tso npe nkag thaum hnub tim ntawm Daim Ntawv Thov no thiab siv tau txij hnub tim ntawm qhov kev duav roos. Kev tsis ceeb toom rau Blue Cross ntawm ib qho kev hloov pauv hauv cov ntaub ntawv muaj nyob rau hauv Daim Ntawv Thov no tuaj yeem ua rau muaj kev tsis kam lees qhov kev thov them nyiaj rov qab, tshem tawm daim ntawv cog lus, tshaj tawm daim ntawv cog lus hloov kho, los sis kev hloov kho nqi tuav pov hwm.
  • Los ntawm kev muab qhov chaw nyob email, kuv pom zoo kom tau txais kev sib txuas lus thiab cov cuab yeej kev lag luam ntsig txog cov phiaj xwm kuv xaiv thiab cov khoom muaj los ntawm los sis tsim muaj los ntawm Blue Cross thiab nws cov chaw koom tes nrog. Kuv tuaj yeem tshem tawm los sis hloov kuv qhov chaw nyob email txhua lub sij hawm los ntawm kev ua raws li cov lus qhia suav nrog hauv txhua qhov kev sib txuas lus hauv email.
  • Los ntawm kev muab tus npawb xov tooj, kuv pom zoo kom lees txais thiab tau txais kev sib txuas lus thiab cov cuab yeej kev lag luam ntsig txog txoj phiaj xwm uas kuv xaiv thiab cov khoom muaj los ntawm Blue Cross thiab nws cov chaw koom tes nrog, los ntawm cov ntawv xa tuaj los sis hu xov tooj rau kuv lub xov tooj thiab rau tus npawb xov tooj me/cov naj npawb tooj ntawm tes uas tau muab rau.
    • NCO TSEG: Kev xa ntawv hauv Email thiab xa kab ntawv tsis tuaj yeem raug lees tab rau kev ruaj ntseg los sis tsis muaj cov ntaub ntawv ua yuam kev uas tuaj yeem tab kaum, cuam tshuam, ploj, puas, tuaj txog lig los sis tsis tiav, los sis muaj cov kab mob. Thaum yog ib tus neeg tau txais email los sis xa kab ntawv los ntawm email los sis khoom siv tsis muaj kev ruaj ntseg, Blue Plus tsis lees txais kev lees tab rau ib qho kev ua yuam kev los sis kev tso tseg hauv cov ntsiab lus ntawm email los sis xa kab ntawv, uas tshwm sim los ntawm email los sis xa kab ntawv mus.
  • Tom qab thov lawm, kuv pom zoo los hloov kho qhov ntaub ntawv ntxiv uas yuav tsum tau muab cuam tshuam txog kev muaj cai tau txais ntawm (cov) tus neeg nyob hauv kev saib xyuas twg uas tso npe rau kev raug pov thaiv. Kuv twb tau nyeem cov lus qhia, cov nqe lus thiab cov lus teb ua ntej no lawm thiab qhia tau tias yog qhov tseeb thiab txhij txhua rau kuv li kev paub thiab kev ntseeg uas zoo tshaj plaws. Kuv nkag siab tias kuv tus kheej los sis kuv cov neeg nyob nrog tsim nyog ua kev tso npe nkag thiab kev duav roos ntawm cov txiaj ntsig raws li qhov kev duav roos kho hniav los sis kho qhov muag no yuav tau nyob tos lub sij hawm los sis ncua sij hawm kaw kev rau npe. Kev duav roos kho hniav tej zaum kuj yog nyob rau ncua sij hawm nyob tos. Kuv nkag siab thiab pom zoo Blue Cross yuav ua raws li cov ntaub ntawv kuv tau muab hauv Daim Ntawv Thov no, uas cuam tshuam rau kev tsim nyog rau kev tso npe thiab tej zaum yuav ua rau muaj kev tsis kam lees cov kev thov them nyiaj rov qab, tshem tawm daim ntawv cog lus, muab daim ntawv cog lus hloov kho, los sis kev hloov kho nqi tuav pov hwm.
  • I understand and agree that payment of a claim does not preclude the right of Blue Cross to deny future claims or take any action it determines appropriate, including seeking repayment of claims already paid. I understand Blue Cross may also seek rescission of the contract in instances of fraud and intentional misrepresentation.
  • Kuv nkag siab tias Qhov Kev Pom Zoo no kho dua tshiab hauv txhua lub xyoo ib puag ncig. I acknowledge that my first premium payment is due by the due date printed on my first invoice. Kuv nkag siab tias kev tsis them ua ntej hnub tag sij hawm no yuav ua rau kuv Daim Ntawv Thov raug tshem tawm. Kuv nkag siab tias cov kev them nyiaj ua ntej ntawm qhov nyiaj yuav yog qhov ntseeg siab rau kuv cov kev them nyiaj lawm yav tom ntej. Kuv nkag siab tias yuav tsum tau txais thiab khiav tej ntaub ntawv them nyiaj kom tiav tso ua ntej yuav pib them tau cov kev thov nyiaj rov qab rau cov kev pab cuam uas tsim nyog twg uas tau txais. Kuv lees paub tias yog tias tsis tau txais kuv cov kev them nqi tuav pov hwm yam tsis tu ncua hauv ncua sij hawm kev them nyiaj ntawm txoj phiaj xwm, kuv txoj phiaj xwm yuav tau txais kev txiav tawm.

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Cov ntaub ntawv kev them nyiaj thiab kev sau nqi

  • Kev duav roos nqi kho hniav, koj tuaj yeem them rau koj cov nqi tuav pov hwm txoj phiaj xwm kho hniav txhua lub hlis ua ntej rau Blue Cross. Yog tias nws yooj yim, koj tuaj yeem them ntau dua li koj cov nyiaj txhua hlis. Peb yuav siv cov nyiaj tshaj hauv txhua lub hli hauv lub xyoo ntawd kiag.
  • Rau kev duav roos nqi kho qhov muag, koj yuav tsum them koj txoj phiaj xwm kho qhov muag cov nqi tuv pov hwm txhua xyoo.
  • Peb yuav tsum tau txais thiab khiav koj cov ntaub ntawv them tus nqi tuav pov hwm tag nrho ua ntej peb tuaj yeem them rau kev thov nyiaj rov qab rau cov kev pab cuam uas muaj cai tau txais twg uas koj tau txais. Yog tias tsis tau txais koj li kev them tus nqi tuav pov hwm hauv ncua sij hawm them tus nqi rau txoj phiaj xwm, koj txoj phiaj xwm yuav tau muab xaus. Hnub xaus kev pov hwm yauv nyob rau lub hli kawg nkaus uas peb tau txais koj li kev them nqi uas yuav tsum tau them. Yuav tsis ua cov kev thov nyiaj rov qab rau cov kev pab cuam uas tsim nyog tshwj tsis yog twb tau them koj cov nqi pov hwm tam sim no tag nrho lawm xwb.

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Kos Npe rau Daim Ntawv Thov

Yog tias tau ua Daim Ntawv Thov no hauv daim ntawv hluav taws xob los sis hauv online, ob tog pom zoo rau kev ua qhov kev them nyiaj no hauv hluav taws xob tau.

 

Thov Ua Kom Tiav Cov Kauj Ruam 1-7

  • Kauj Ruam 1) Qhia peb txog koj tus kheej
  • Kauj Ruam 2) Qhia peb txog koj yim neeg
  • Kauj Ruam 3) Xaiv ib txoj phiaj xwm thiab them nyiaj
  • Kauj Ruam 4) Qhia peb yog tias koj muaj lwm qhov kev tuav pov hwm kho hniv thiab/los sis kho qhov muag
  • Kauj Ruam 5) Tshuaj xyuas cov ntawv ceeb toom thiab cov ntaub ntawv kev tso cai
  • Kauj Ruam 6) Tshuaj Xyuas kev them nyiaj thiab cov ntaub ntawv sau nqi
  • Kauj Ruam 7) Kos Npe Daim Ntawv Thov

Yog tias Daim Ntawv Thov no tau muab ua tiav los ntawm tus neeg sawv cev/tus neeg tsim, thov ua kom tiav thiab xa Daim Ntawv Lees Txais Ntawm Tus Neeg Tsim rov tuaj ua ke nrog tag nrho Daim Ntawv Thov uas tau ua tiav lawm.

Daim Foos Tso Npe Hauv Online

Cia Rau Tus Neeg Tsim Siv Nkaus Xwb

Tus Neeg Tsim Daim Ntawv Pov Thawj

Tus Neeg Tsim Yuav Tau Mob Siab Rau: Yog tias koj muaj cov nqe lus nug txog kev ua Daim Ntawv Thov, thov hu rau Tus Neeg Tsim Tus Xov Tooj tau ntawm 1-888-878-0138.

Yog tias tsis tau ua ntu no kom tiav txhij txhua, koj yuav tsis tau txais kev cob rau tam li yog tus AOR.

Tus Neeg Tsim yuav tsum ua kom tiav ntu no los sawv cev tam rau tus neeg Ua Ntawv Thov.

Kuv lees paub tias kuv tau tshuaj xyuas Daim Ntawv Thov ua tiav nrog Tus (Cov) Neeg Thov thiab:

  • Kuv lees tias kuv twb ua tau raws li cov cai uas tau teev cia hauv xeev Minnesota Txoj Kev Cai Lij Choj 60K.46 feem hauj lwm 4 hais txog kev tsim nyog, ua ke nrog cov cai ntawd uas tau teeb txog Tsab Cai Kev Coj Ua Ntawm Tus Neeg Sawv Cev thiab hauv Blue Cross and Blue Shield of Minnesota thiab Blue Plus daim ntawv cog lus. Nco cim tseg: Mus saib Lub Chaw Hauj Lwm Sawv Cev thiab tshawb xyuas rau "Tsab Cai Kev Coj Ua Lub Chaw Sawv Cev".
  • Kuv tsis paub, raws li Tus Neeg Thov cov lus teb rau kuv cov lus nug, ntawm ib feem twg cuam tshuam rau kev muaj cai ntawm Tus Neeg Thov thiab nws txhua tus neeg nyob nrog uas thov rau kev duav roos
  • Kuv nkag siab ntxiv tias tsis muaj ib tus neeg tsim yuav lees txais kev pheej hmoo los sis hla ntawm ib qho yuav tsum tau ua kom muaj cai, ua los sis hloov pauv ib cov ntsiab lus ntawm Daim Ntawv Thov los sis tsab cai, los sis zam ib cov cai cog lus los sis cov yuav tsum muaj.
  • Kuv lees paub tias Tus Neeg Thov tau nyob ntawd thiab tau kos npe rau Daim Ntawv Thov uas muaj kuv nyob ua ke ntawd thiab.
  • Kuv tau muab ib daim ntawv theej ntawm Daim Ntawv Thov uas tau xa lawm rau (Cov) Tus Neeg Thov, tag nrho txhij txhua, kiag tam sim ntawd yam muaj kev nyab xeeb raws li txhua cov cai lij choj uas siv tau
  • Kuv pom zoo los khaws ib daim ntawv theej ntawm Daim Ntawv Thov uas tau xav lawm rau kuv khaws cia thiab muab ib daim ntawv theej ntawm Daim Ntawv Thov uas tau xa mus rau Blue Plus thaum uas lawv thov.

You must be a resident of Minnesota to buy or renew individual coverage from Blue Cross and Blue Shield of Minnesota or Blue Plus. View residency policy

Coverage will be provided under an individual contract. Blue Cross tsis tawm kev raug pov thaiv rau ib tug neeg dhau ntawm kev npaj cia nrog tus tswv hauj lwm.

These plans do not meet the minimum essential health benefit requirements for pediatric oral health and pediatric vision coverage as required under the Affordable Care Act.

Qee qhov kev them nyiaj thib peb tej zaum yuav tsis raug lees txais.