BlueCross and BlueShield of Minnesota is proud to sponsor and support you in your efforts to quit.

Program Enrollment


Step 1: Personal Information
Enter your information in the fields below and click the NEXT button to continue. All fields are required.
First Name:    
Last Name:    
Middle Initial:
(Optional)
Date of Birth (MM/DD/YYYY):    
(Must be 18 or older to enroll)

Is your mailing address in the US/US Territory?
Address 1:    
Address 2:   (Optional)
City:    
State:     
Zip Code:      
 

Language:
What type(s) of tobacco have you used in the last 30 days?
(Check all that apply).



   
Who is your Employer?  
 

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