Agent of Record - Let us help you through claims or policy questions, rate increases and making changes to your policy at NO COST TO YOU! Print off and fax this form for immediate service! (Must have had your BCBS policy for 12 months.) Application & Change Form - Health - Paper App (not for employer/employee use) for faxing or mailing. Call our office for processing instructions. Bank Draft - Set up bank draft or change your current draft. (One is included with the application.) Brochure - HSA Compatible Plans - High deductible plans that your CPA has recommended for tax savings! Brochure - Tonik PPO Plan - Newest plan for young adults who live life to it's fullest. Includes dental and vision benefits! Dental - Brochure - Monthly Rates: Individual $27 Family $76 Dental Application - Use only if adding dental to your current heath plan OR if applying for dental without a current health plan. Medicare Supplement Brochure - For 65+ individuals with Medicare Parts A & B. Short Term Medical Application - Faxable application for immediate short term plan. Short Term Medical Brochure & Rates - Immediate coverage up to 12 months. SmartSense & Premier Plan Benefits - BCBS's newest plan PPO and POS Plans. Vision for Singles or Families - New VISION PLAN only $10 for single policyholders or $24 for the entire family! Vision Information - Detailed info about how the Vision Plan works.
