Individual & Family Plans

Download application forms for standard individual and family health plans from a variety of providers, as well as temporary health plans, Medigap plans and more.

Standard Health Plans

• Aetna
  • Application
  • Medical Claim Form
• Anthem Blue Cross of California
  • Application
  • Change of Coverage Form
• Blue Shield of California
  • Application
• Health Net
  • Application
• Health Net of California Farm Bureau
  • Online Application
  • Application
• Kaiser Permanente
  • Application
• PacifiCare
  • HMO Application
  • PPO Application

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Temporary Health Plans

• Anthem BC Life and Health Insurance Company
  • Application
• Assurant
  • Application
• Health Net
  • Application

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Medigap Plans

• Anthem Blue Cross of California
  • AdvantageCare Application
  • Part D Application
  • Senior Classic Application
  • SmartChoice Application
• Blue Shield
  • Application
  • AutoPay Form
• Health Net of California Farm Bureau
  • Application

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Medicare Advantage Plans

• Anthem Blue Cross of California
  • Freedom Blue Application
  • Senior Secure Application
  • SmartValue Application

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Dental Plans

• Aetna
  • Dental Claim Form
• Anthem Blue Cross of California
  • Dental Blue Application
  • HMO Application
  • PPO Application
  • Senior HMO Application
  • Senior PPO Application
  • SmileNet Application
• Blue Shield
  • Application
• Delta Dental MorganWhite
  • Application
• DeltaDental
  • Application
  • Senior Application
• First Dental Health
  • Application
• Golden West
  • Application
• Kaiser Permanente
  • Application
• Multiflex
  • Security Life Application
  • Symetra Life Application
• PacifiCare
  • Application
• SafeGuard
  • Classic and Premier - Application
• Standard Life MorganWhite
  • Application

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