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What is special enrollment?

Federal law allows people to enroll in a new health plan only during an open enrollment period. Outside of that period, you can enroll only if you have a significant life change.

Qualifying life changes include a change in family or job status that would otherwise leave you without health insurance.

Attention: Only agents that are currently appointed with BCBSND are authorized to submit applications. If you are not appointed or are unsure of your appointment status with BCBSND contact marketingsupportcoordinators@bcbsnd.com prior to submitting any applications.

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BlueCare 70 2000

The most coverage with the most predictable costs.

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You may qualify for premium tax credit and may qualify for cost-sharing as well.

To apply with the tax credit, call 800-280-2583 or schedule a virtual or in-person appointment with BCBSND Sales.

You may qualify for a premium tax credit. The amount shown is an estimate and may vary.

To apply with the tax credit, call 800-280-2583 or schedule a virtual or in-person appointment with BCBSND Sales.

Apply online without the tax credit: Apply now

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BlueCare 70 2000

Change Plan

$1250.50

2 Adults, 2 Dependents

Monthly Premium

Nov 1, 2020

Coverage Start Date

Subscriber Information

*Required Fields

We only offer coverage to residents of North Dakota. Call 800-280-2583 if you feel you qualify.

How Can We Contact You?

*Required Fields

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We need documentation to support your qualifying life event

Max size for upload is 2MB. Acceptable file formats include: .pdf and image files.

    Mail Documentation

    Your application will not be completed until we receive your documentation. If you do not have it at this time, you may mail it to our Fargo Headquarters.

    Include the following:

    • Your full name
    • Reference: Member application

    Blue Cross Blue Shield of North Dakota
    Attn: Consumer Sales
    4510 13th Ave. S.
    Fargo, ND 58121


    Now, we need more details about your spouse and dependents

    BlueCare 70 2000

    $1250.50

    2 Adults, 2 Dependents

    Monthly Premium

    Nov 1, 2020

    Coverage Start Date

    Subscriber, Spouse and dependents

    Subscriber Hide - Show +

    Dependent Hide - Show +

    Subscriber signature

    Terms and Conditions

    I understand that any company(s) with which I am applying for coverage reserves the right to accept or decline this application in whole or in part. I further understand that no contractual right is created by this application or advance premium payment and the same shall not be considered accepted unless or until the Benefit Plan is issued to me.

    I have read this application in its entirety and understand and acknowledge that the accuracy and sufficiency of the information I provide (or fail to provide) in each and every section of this application serves as the basis in determining my eligibility (and the eligibility of my dependents) for coverage and receiving a Benefit Plan(s), and by signing this application I certify the information is accurate and complete. I understand and agree that inaccurate, incomplete, or omitted information represented in this application may constitute a fraudulent act or intentional misrepresentation of material facts voiding or retroactively cancelling any Benefit Plan(s) issued, as well as any claims for medical benefits and services paid, based on the information I submit through this application.

    I further understand a person who submits an application or files a claim with intend to defraud or helps commit a fraud against an insurer is guilty of a crime.

    By checking this box, I understand I am creating an electronic signature that carries the same legal obligations as a written signature and am agreeing to all of the terms and conditions set forth within this application, including the Notification and Authorization.

    Agent Signature

    Note: Include leading zeros in BCBSND Agent Number and BCBSND Agency Number.

    By checking this box, I understand I am creating an electronic signature that carries the same legal obligations as a written signature and am agreeing to all of the terms and conditions set forth within this application, including the Notification and Authorization.

    I am submitting this application on behalf of the individual signee. I have received verbal or written consent from the individual to submit the application. The application accurately reflects the information provided. I have printed a copy of the application and provided it to the individual signee.

    Print this page for your records before submitting the application.