Blue Shield of California  OLEG SKURSKIY (818) 987-5000  

Authorized Agent for Blue Shield of California

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Blue Shield of California Medicare Supplement
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All application should be mail the Address below for Complete Review .

Mail application to:

Oleg Skurskiy
18375 Ventura Blvd. # 226
Tarzana , CA 91356


You also can fax complete application to Fax # : 1-818-776-9865

Contact Us

Learn the Basics  
What is Medicare?
Medicare is a federal health insurance program for people 65 years and older, people of any age with permanent kidney failure and certain younger people with disabilities. The Original (also called traditional) Medicare Plan has two parts:
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Part A helps pay for inpatient hospital, skilled nursing facility, limited home health and hospice care.

Part B helps pay for doctor's services and outpatient hospital services. It also covers diagnostic tests, ambulance transport, preventive care including mammography and Pap tests and durable medical equipment and supplies.
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Medicare's new prescription drug coverage, also known as the Medicare Part D Prescription Drug Plan, begins on January 1, 2006. It helps pay for prescription costs. Unlike Parts A and B, Part D is not available through the government. It must be purchased from private companies who have the Centers for Medicare and Medicaid Services (CMS) approval to offer a Prescription Drug Plan.
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Almost everyone age 65 and older pays no monthly premium for Medicare Part A, because they or their spouse paid Medicare taxes while they were working. However, you may be eligible to buy Part A if you did not pay Medicare taxes while you worked. Medicare beneficiaries are also responsible for Part A deductibles and coinsurance.

To be covered by voluntary Part B, you have to pay a monthly premium. In 2006, the Part B premium is $88.50 per month for most beneficiaries. This amount may change January 1, 2007.

You are eligible for Medicare if you fall into any of these categories:
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You are age 65 or older and eligible for Social Security or Railroad Retirement benefits.

You are 65 or older and married to someone eligible for Social Security or Railroad Retirement benefits.

You've been receiving Social Security disability benefits for at least 24 months.

You have End-Stage Renal Disease (kidney failure).
What does Blue Shield have to do with Medicare?
You shouldn't expect Original Medicare to cover all your healthcare needs. Many medical services and supplies are not covered.
Blue Shield offers both Medicare Supplement Plans and a stand-alone Medicare Prescription Drug Plan to enhance Original Medicare coverage. We also offer a Medicare Advantage-Prescription Drug Plan which includes everything Original Medicare covers, Medicare Part D coverage and additional benefits not covered by Medicare.
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Instructions :

For your own protection, you, the applicant, must complete the application. You are solely responsible for its accuracy and completeness.

All information must be stated accurately.

All questions must be answered in full or the application may be returned to you and may result in a delay in processing.

For additional information or explanations, attach additional sheets if necessary. All attachments must be signed and dated.

This application must be completed and signed in blue or black ink. Sign and date Part 8 of the application. Signatures are required for all applicants, including your spouse and dependents age 18 and older.

This application must be received within 30 days from signature date.

Even if the application is approved, any misstatements or omissions may result in future claims being denied and the plan being voided from the beginning.

Your insurance will become effective only if this application is approved as applied for, the appropriate premium is enclosed, and other specific conditions are met.

Please return this application and your check to Make Check payable to "Blue Cross of California" or " Blue Shield of California")

Include your check or money order made payable to "Blue Cross of California" , " Blue Shield of California" .

If you have any questions please call us at (818) 987-5000

Blue Shield® and the Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an Association of Independent Blue Cross and Blue Shield plans. Easy$PaySM is a service mark of Blue Shield of California.
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