Forms

Change of Address Form

• Change of Address Form – use this form to notify us if you have moved.

Travel Insurance

• IMG – Get Quote, Plan Details or Apply Online

Individual & Families Insurance Forms

Independence Blue Cross – Personal Choice PPO and Keystone HMO Health Plans

• Plan Rates 2020
• Plan Summaries 2020
• Enrollment form 2020
• Plan Rates 2019
• Plan Summaries 2019
• Enrollment form 2019

Aetna Advantage Health Plans

• Contact Brad or Randy for more info

Short Term Medical Plans

• Contact Randy or Brad for a short term medical quote

Dental Plans

• Delta for Everyone (apply online or get a quote)
• Independence Adult Dental 2020 (pdf)
• Independent Adult Dental application form (pdf)

Business & Group Insurance Forms

Independence Blue Cross – Keystone and Personal Choice

• Small Group Plan Guide 2020 (pdf)
• Employer application
• Employee enrollment form

Contractors Professional Liability Forms

• Contractors Professional Liability Application (pdf)

Insurance Request Forms

• Certificate of Insurance Request form – use this form to notify us if you need a certificate of insurance coverage