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 2022
• Plan Summaries 2022
• Enrollment Form 2022
• Plan Rates 2021
• Plan Summaries 2021
• Enrollment form 2021

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 & Vision 2022 (pdf)
• Independent Adult Dental application form (pdf)

Business & Group Insurance Forms

Independence Blue Cross – Keystone and Personal Choice

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

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