BlueRideSM from Blue Plus offers you a safe and reliable ride to covered medical, dental, and pharmacy visits with doctors in your plan network. You can also use BlueRide to go to participating fitness locations, health and wellbeing classes, and Narcotics Anonymous and Alcoholics Anonymous meetings.\* **BlueRide offers rides for the following:** - Medical appointments - Dental appointments - Mental health appointments - Prescription pick ups - Durable medical equipment (DME) pick ups or repairs - Fitness facility visits (SecureBlue members only) ### Eligibility You may be able to get a ride to eligible medical appointments if you do not have access to your own ride and are a member of one of these Blue Plus plans: - Blue Advantage Families and Children - MinnesotaCare (pregnant women & members under age 19) - Minnesota Senior Care Plus (MSC+) - SecureBlue (HMO SNP) ### How BlueRide works A BlueRide representative will make sure you are eligible. If you are, you may receive one of these services: - A public bus pass if you live in a public transit service area - A scheduled medical ride or other ride service if you live outside a public transit service area ### Scheduling a ride Fill out the form below to schedule your ride appointment at least five business days before your desired ride date. You may also call **866-340-8648** to schedule your ride appointment at least two business days before your desired ride date. If you need to change or cancel your ride, call BlueRide as soon as possible, with a minimum of four hours before your scheduled pick-up time. Failure to cancel unneeded rides may result in temporary loss of BlueRide services. Pick-up time is up to sixty minutes before your appointment. The driver will wait five minutes at your pick-up location. Respectful behavior is required for the duration of the ride. If you have a disability or other special needs, BlueRide will find another type of ride to meet your needs. ### Children traveling alone A minor child under the age of 18 traveling alone will need to have a consent form signed by a parent or guardian before rides can be scheduled for them. Email form to: Or fax form to: (651) 662-2844 [BlueRide consent form](https://bluecrossmn.widen.net/content/qjnkpgkoge/original/m07880-blueride-guardian-permission-travel-form.pdf "m07880-blueride-guardian-permission-travel-form.pdf") ### Grocery rides If you live in one of the following Minnesota counties, you may qualify for rides to the grocery store or local food pantry. - Benton County - Blue Earth County - Carlton County - Clay County - Kandiyohi County - Mower County - Pine County - Rice County - Sherburne County - Stearns County - Winona County Use our Community Resource Link if you need help finding a grocery store or food pantry. [Find a grocery store or food pantry](https://mnbcbs.findhelp.com/) Call toll-free **1-866-340-8648,** TTY **711** or **(651) 662-8648** Monday through Friday, 8 a.m. to 5 p.m. ## Disclaimers: This form may be used for new ride requests and if your appointment date is **5 business days or more before your ride request**. Call BlueRide Member Services ([866-340-8648](tel:+18663408648)) if: - You're calling for a ride less than 5 days before your appointment date - You need to make a change to your ride (edit, cancel, etc.) **What you should know after you send the form in:** - Please allow 48 hours for your ride to be scheduled. Once your ride has been set up, you will get an email from BCBSMN with the company name, their phone number and your ride details. - Call the ride company two days before your ride to make sure it was received. For your return ride, you must call the transportation company. --- ## Member Information: Member First Name Member Last Name Blue Cross and Blue Shield Member ID? Date of Birth Phone Number Email Address (for ride request follow up) Are you the member filling this form out for yourself? Yes No --- ## Your Information: What is your relationship to the member? Your phone number Your first name Your last name Are you calling from an organization (facility, agency, etc.)? Yes No Agency Name/Facility Your title and NPI # --- ## Ride Type: Do you need help getting to and from the vehicle? Yes No Which of the following do you need assistance with? Walking Wheelchair Stretcher Which of the following best describes your wheelchair? Extra Wide Electric Powered Power Scooter Standard Which of the following best describes your stretcher? Standard Extra Large (Bariatric) Enter the total weight (pounds) of yourself and your equipment --- ## Trip Details: Ride date What time is your appointment? Rides cannot be scheduled in the past. Please call BlueRide at [866-340-8648 - Opens in a new window](tel:+18663408648) for additional information. Your appointment is less than 5 business days away. To schedule a ride within this shorter timeframe, please call BlueRide Member Services at [866-340-8648 - Opens in a new window](tel:+18663408648). Rides cannot be scheduled more than 31 days out. Please call BlueRide at [866-340-8648 - Opens in a new window](tel:+18663408648) for additional information. Rides are not available on weekends and some holidays. Please choose a date Monday through Friday or call BlueRide at [866-340-8648 - Opens in a new window](tel:+18663408648) for additional information. Appointment type Behavioral/Mental Health & Chemical Dependency Dental Dialysis Discharge Methadone Primary Provider Visit Specialist Provider Visit Other What is the reason for your appointment?? Is anyone else riding with you? Yes No Number of adults riding with you Number of children riding with you Will you be using a car seat? Yes No The transportation company can provide 1 car seat. Please select "Yes" if you need one provided. If additional car seats are needed, you will need to provide those. Yes, I need one provided by the transportation company I will provide my own car seat(s) What type of car seat is needed? Forward facing Rear facing How many car seats will you be providing? Will you be using a booster seat? Yes No The transportation company can provide 1 booster seat. Please select "Yes" if you need one provided. If additional booster seats are needed, you will need to provide those. Yes, I need one provided by the transportation company I will provide my own booster seat(s) How many booster seats will you be providing? --- ## Pick Up Details: Pick up location Home Other Pick up location name (work, relative's house, friend's house, etc) Address City/Town State - Select -IowaMinnesotaNorth DakotaSouth DakotaWisconsin ZIP/Postal Code --- ## Drop Off Details: Drop off location (hospital, clinic, etc) Address City/Town State - Select -IowaMinnesotaNorth DakotaSouth DakotaWisconsin ZIP/Postal Code Ride type One-way Round-trip --- ## Return Trip Details: Expected pick up time: Is your post-appointment drop off location the same as where you were picked up? Yes No Post-appointment - drop off location Home Other Post-appointment - drop off location name (work, relative's house, friend's house, etc) Address City/Town State - Select -IowaMinnesotaNorth DakotaSouth DakotaWisconsin ZIP/Postal Code --- Are there any special instructions you would like us to be aware of? \*Restrictions and Conditions apply. SecureBlueSM (HMO SNP) is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in SecureBlue (HMO SNP) depends on contract renewal. DHS\_100424\_K01 DHS Approved 11/19/2024 H2425\_070723\_O04 CMS Accepted 07/19/2023