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Call Center
1(800) 236-4782
Providing the best insurance coverage for the residents of the State of Michigan and specialize in assisting Michigan HCTC Qualified Members and their dependents.
MEDICAL, PRESCRIPTION DRUG, DENTAL & VISION BUNDLED PPO PLANS
PLANS
COMMUNITY BLUE PPO HCTC-1
SIMPLE BLUE PPO HCTC-2
SIMPLY BLUE PPO HCA HCTC-3
3 PLANS CURRENTLY AVAILABLE
FOR IMMEDIATE ENROLLMENT

ready to
enroll for 2021?

ALL FOUR BENEFITS FOR ONE PRICE!
BUNDLED PLANS INCLUDE:
MEDICAL
PRESCRIPTION DRUG
DENTAL
VISION









Call us today to help you enroll!! 1-844-428-2669
REQUIRED FORM THAT MUST BE COMPLETED FOR MICHIGAN STATE RESIDENTS ENROLLMENT
REQUIRED FORMS THAT MUST BE COMPLETED FOR HCTC ENROLLMENT
IT IS EXTREMELY IMPORTANT FOR THE FORMS TO BE FILLED OUT PROPERLY AND COMPLETELY.
SEE SAMPLES BELOW FOR A GUIDE.

TO ENTER THE HCTC PROGRAM, you actually enroll in two programs. The two programs you will enroll in are: 1.) HCTC Program when you complete the 13441-A ENROLLMENT FORM (IRS/HCTC) AND
2.) The Insurance Program when you complete the BCBSM ENROLLMENT FORM (BLUE CROSS BLUE SHIELD OF MICHIGAN).
YOU MUST ALSO PROVIDE a copy of your HCTC Eligible Supporting Documents (IRS form 1099R or paycheck stub)
SAMPLES OF FORMS THAT MUST BE COMPLETED FOR HCTC ENROLLMENT
Call us
1 (800) 236-4782
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