Forms and Materials

• Individual Care Blue Plus Enrollment Kit and Brochure (737K PDF)
• Individual Care Blue Plus Benefits (86K 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)
• Change of Status Request Form (81K PDF)
• Auto Payment (61K PDF)