Application for Individual Coverage
Who is this for?
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.
Questions? If you're a new customer, call one of our health plan advisors at 1-855-237-3501. Already a customer? Call the Customer Service number on the back of your ID card.
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
- Individual and family health insurance - check out our MyBlue℠ plan options designed to fit your health care needs and your budget.
- How to purchase individual health insurance
- How can I know I'm purchasing the right health insurance policy
- Health Insurance 101