Michigan Business & Professional Association


Please ensure that MBPA is noted on all BCBS or BCN enrollment documents. This will help ensure the member is put into our sponsored group plan and the insurance agent receives proper commission.
Selling Agent
Name
Email
BCBSM ID#
Managing Agent

Plan	BCBS BCN Other Specify
Group No.
Effective Date
Member Information
Company Name
Member Representative
First Name
Last Name
Title
Phone
Email

F. (586) 393-8810