1 (888) 288-4398 TTY 711

Advance Directives and Other Legal Documents

All states have laws that allow individuals to make future healthcare treatment decisions, in the event we are unable to make or communicate our own decisions later. This enables our family and doctors to understand the type of medical care we want or do not want. State laws also allow us to appoint a person to make future healthcare treatment decisions for us if we are unable to make them for ourselves. The documents related to these laws are called “advance directives.” Learn more about these legal documents:

Advance Directive Notice
AZ Blue has partnered with Five Wishes, which is a tool that may be helpful when thinking about documenting your healthcare choices. Find more information on the videos linked below:

Five Wishes Preview video
Five Wishes Waiting Room video

Appointment of Representative (AOR) Instructions

AOR Form – English
AOR Form – Español

Confidential Information Release (CIR) Form - English
Confidential Information Release (CIR) Form - Español
Confidential Information Release for HIV related - English
Confidential Information Release For HIV related - Español 

AZ Blue is committed to complying with these state laws and with the federal law regarding the distribution of advance directive information to our members upon enrollment. We cannot refuse care or discriminate against you based on whether or not you have completed an advance directive. We educate our staff about advance directive rights and procedures and offer community education on these rights. AZ Blue documents whether or not members have advance directives in a prominent part of their current medical records. Learn more in Chapter 8, “Your rights and responsibilities,” in your plan Evidence of Coverage (EOC).

    Blue Cross® Blue Shield® of Arizona (AZ Blue) is contracted with Medicare to offer HMO and PPO Medicare Advantage plans and PDP plans. Enrollment in AZ Blue plans depends on contract renewal.

    AZ Blue offers BlueJourney PPO Medicare Advantage plans. AZ Blue Advantage, a separate but wholly owned subsidiary of AZ Blue, offers Best Blue Life Classic and Plus HMO plans.

    You are eligible to enroll in a AZ Blue Medicare Supplement plan if you are age 65 or older, entitled to Medicare Part A, and enrolled in Medicare Part B, and you live in the plan service area. You must continue to pay your Medicare Part B premiums (and Part A, if applicable), if not otherwise paid for by Medicaid or another third party. During the first six months when you are age 65 and also enrolled in Medicare Parts A & B you cannot be denied a Medicare Supplement plan when you apply for one, regardless of health status.

    Health Choice Pathway HMO D-SNP is a Health Plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Health Choice Pathway HMO D-SNP depends on contract renewal. Health Choice Pathway Member Services can be reached at 1-800-656-8991, TTY: 711, 8 a.m. to 8 p.m., 7 days a week.

    Blue Cross Blue Shield of Arizona (AZ Blue) and Health Choice Arizona (HCA) comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We provide free aids and services to people with disabilities to communicate effectively with us, such as qualified interpreters and written information in other formats such as large print and accessible electronic formats. We also provide free language services to people whose primary language is not English, such as qualified interpreters and written information in other languages. If you need these services call 1-800-446-8331 (TTY: 711) for AZ Blue Medicare Advantage or 1-844-883-8524 (TTY: 711) for AZ Blue Blue MedicareRx (PDP) or 1-800-656-8991 (TTY: 711) for HCA.

    Member Services can be reached at 480-937-0409 (in Arizona) or at our toll-free phone number at 1-800-446-8331 (TTY users should call 711). Hours are 8 a.m. to 8 p.m., Monday through Friday from April 1 to September 30; and 7 days a week from October 1 to March 31. Member Services also has free language interpreter services available for non-English speakers.

    OptumRx® is an independent company providing prescription mail order services.

    Spanish (AZ Blue): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-446-8331 (TTY: 711).

    Navajo (AZ Blue): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-446-8331 (TTY: 711).

    Spanish (HCA): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-656-8991 (TTY: 711).

    Navajo (HCA): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-656-8991 (TTY: 711).

    Y0137_M40278PY25_M
    Last Updated 10/01/2024