Blue Cross Blue Shield Online Application Process

1. Blue Cross Blue Shield Online Application Process

2. Lets get started! WWW.NEBRASKABLUE.COM • CLICK ON THE BROKER TAB

3. Log onto broker site USERNAME: bcbsne Password: nebraska

4. Scroll down the page until you come to Medicare Plans

5. Scroll down the page until you find which application you are looking for. The example to the right is Medicare Supplements Application Click on the DRX link

6. Blue Cross Blue Shield of Nebraska - Sign In These credentials are your own! Make sure you save and bookmark this page if your computer is secured. If you can not remember your username or password please contact: 1888-232-0942 broker_appointment@nebraskablue.com

7. Blue Cross Blue Shield of Nebraska - Dashboard Click on “Start New Enrollment”

8. Blue Cross Blue Shield of Nebraska - Enroll Now! Enter the clients Zip code and click SUBMIT

9. Blue Cross Blue Shield of Nebraska - Enroll Now! Click on: Medicare Supplement See available plans

10. Blue Cross Blue Shield of Nebraska - Enroll Now! Fill out Clients information for Plans to populate Date of Birth Effective Date of Coverage Gender Tobacco use Household discount Click Continue

11. Blue Cross Blue Shield of Nebraska - Enroll Now! Determine which Plan best fits your client needs. Click Enroll

12. Blue Cross Blue Shield of Nebraska - If you client would like to add on a Dental Plan please select Options 1, 2, 3, or 4. You DO NOT need to select one in order to continue with the application process CLICK ENROLL

13. Blue Cross Blue Shield of Nebraska - Enroll Medigap You will need to click, “I acknowledge I have read the above documents and fully understand their contents.” box before moving forward with the application process. Click CONTINUE

14. Application: Fill in the your clients personal information in the spaces. *Fields marked with an asterisk are required* If your client DOES NOT have an email address you can use None@none.com At the bottom of this page, click continue

15. Enter in the Clients Medicare Number Hospital Insurance Effective Date (Part A) Medical Insurance Effective Date (Part B) Click Continue

16. Medicare Supplement Questions Fill out the “Yes” or “No” questions then click continue.

17. Blue Cross Blue Shield of Nebraska - Enrollment Form Choose their method of payment: Monthly paper bill– If they choose this method then click continue to bring you to the next page of the application Monthly automatic bank withdrawal- fill in the boxes that populate after selecting. Click Continue

18. Blue Cross Blue Shield of Nebraska - Enrollment Form Review all the information you have submitted to ensure its all correct. Click the small box located below the document to confirm that you have reviewed the information. Click Complete Review

19. Blue Cross Blue Shield of Nebraska - Enrollment Form Check these! Make sure you have supplied the Client with: Outlines of Coverage Choosing a Medigap Policy It will automatically fill in the earlier effective date with the information you entered on a previous page. Click the last box to authorize your E-signature. Click Continue Automatically will fill in from previous page Check Here!

20. Blue Cross Blue Shield of Nebraska - Enrollment Form Information to Consider…. Click Continue once done reading.

21. Blue Cross Blue Shield of Nebraska - Enrollment Form Select one For OEP select “Other”

22. Both, client and agent, Electronically Sign the document. Fill in Agent Number (This is in AGB if unknown)

23. Agent Section: Fill in the boxes with the requested information. Upload the paper application if on hand. Click “Submit Enrollment” After you submit your application, there will be a print icon in the top right side of the screen. Print the application and enrollment confirmation and email these to Medicare@ociservices.com. *In case of an audit, OCI will have all the required documents to help better assist you with. *

24. YOU DID IT!!