Vermont Medigap Blue Form

Turning/turned 65

New disability

Other new subscriber

Please be aware if you are a new Blue Cross Blue Shield of Vermont member, your first months premium payment is due within 10 days of the receipt of the application. You may drop off your payment at our Berlin location. You can also mail your payment directly to Blue Cross Blue Shield of Vermont, PO Box 186, Montpelier, VT 05601. Please include your confirmation number in the memo portion of the check.

To make changes to, or cancel your coverage, please contact one of our Medicare Specialists at 1-800-255-4550, Monday – Friday (8am-4:30pm)