Enter the following information and we'll help you calculate your BlueElite Medicare Supplement Plan premium. All fields are required. Enter your Zip Code/County: Required Error: Zip Code is required. Date of Birth: (format: mm/dd/yyyy) Date of Birth is blank. Hospital (Part A) Effective Date: Hospital (Part A) Effective Date is blank. MM/DD/YYYY Gender: Male Female Please select gender for the Primary Applicant Tobacco users may be subject to a 10% increase in rates. Tobacco rates don't apply if you're in a Medigap Open Enrollment or Guaranteed Issue Period. To find out if you're eligible for a Medigap Open Enrollment or Guaranteed Issue Period, call your local agent or contact us at 1-888-770-8840 (TTY users dial 711). Have you used any form of tobacco in the past 12 months? Yes No Please provide a valid response Requested Effective Date: 06/01/202207/01/202208/01/2022 Continue
