Replacement Card Request

 
Replacement Card Request

Please complete the electronic form below to order a replacement ID card. You must provide your phone number in case we need to verify information. Please allow two weeks for delivery of your replacement card. You can also order a replacement card by calling the Blue Cross Blue Shield Customer Service Center at (800) 537-9765.

* Indicates a Required Field

   
 
Member Name: *
Group Number: *
Phone: *
Street 1: *
Street 2:
City: *
State: *
Zip: *
Who Needs the Card? *