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Application for Individual Coverage

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you're ready to apply for one of our individual and family plans, use this application.

Found one of our individual and family plans that's right for you? Use this application to apply for these plans: 2014 catastrophic (Value), bronze, silver and gold plans (Blue Cross® Partnered, Select, Preferred, Premier) and Blue Dental℠ Personal plans. 

What to do:

Open enrollment for 2014 plans is now closed. You can only enroll in a new plan if you've had a change in your life circumstances. Check to see if you qualify for a special enrollment period

If you qualify, and you're not eligible for a subsidy, you can use this application to apply.

What you'll need:

  • Social Security number or tax ID number and date of birth for everyone who'll be covered by the plan
  • A credit card if you want to make your first payment that way
  • A printer to print the form 
  • An envelope and postage to mail the form

Other options:

If you'd like to apply online, you can start by getting a quote.

If you're interested in a plan with a subsidy, please apply online or call a health plan advisor at 1-855-237-3501.

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