Flexible Blue II Forms and Materials

• MyBlue Flexible Blue II brochure (605K PDF)
• Flexible Blue II 1500 Benefits (90K PDF)
• Flexible Blue II 2500 Benefits (89K PDF)
• Flexible Blue II 5000 Benefits (87K PDF)
• Application (76K PDF)
• Application for Waiver of Pre-Existing Waiting Period (PDF) (Please print and submit this form at the time of application.)
• Optional Dental Benefits (62K PDF)
• Optional Maternity Benefits (52K PDF)
• Change of Status Request Form (81K PDF)
• Auto Payment (61K PDF)

Health Savings Accounts

Flexible Blue II pairs an affordable health plan with a bank account where the group or member can set aside pre-tax funds for qualified medical expenses. Wells Fargo is our preferred financial services company for Health Savings Accounts (HSAs). For more information about Wells Fargo health care spending accounts, visit Wells Fargo's Web site.