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Regence BlueCross BlueShield of Oregon

Request for Medicare Plan Information

* Required Fields
Home Address
* First Name
* Last Name
* Street Address
* City
* State
* Zip
* Phone Number
E-Mail
 
   Use a separate mailing address.
Which plan information are you interested in?
   Regence MedAdvantage, Regence MedAdvantage + Rx Core,
Regence MedAdvantage + Rx Classic, and Regence MedAdvantage + Rx Enhanced**†
   Part D Prescription Drug Coverage Only†
   Companion Plans (Medicare Supplement)
   Preferred Choice Sixty-Five (Preferred Choice Sixty-Five is only available through December 31, 2008.)**
**These products are available in limited counties.
†Please indicate in the comment box below whether you would like plan information for coverage in 2008 or for coverage starting January 1, 2009.
How would you prefer to be contacted?
   E-mail
   Post mail
   Phone
Comments and suggestions: