New for 2018

Benefit changes for 2018 plans

New paper application

  • 2018 fillable PDF applications are available online. Please DO NOT fax applications.
  • Please email to
  • The 2018 application is a multi-use document. Use the application for new enrollments and changes to existing policies. The application modification, plan selection, and plan change forms have been discontinued.  

New application effective dates

  • All effective dates will be the 1st of the month.
  • Applications received after the 15th will be assigned the effective date of the 1st of the second following month. If the premium is paid prior to the 22nd of the current month, the member can have the 1st of the next month’s effective date. Example: Application received on December 16 will be assigned February 1 effective date. Premium must be paid by December 22 to receive a January 1 effective date.
  • In order for coverage to begin on (date assigned) we must receive payment prior to (date assigned), or within 14 days of the date of the request for payment letter, whichever is later.
  • Note that due to increased sensitivity to handling credit card numbers over the phone, we are strongly encouraging applicants and members to primarily use online credit card and check payment options.
  • If the effective date falls on a non-business day, binder payments will be accepted on the next business day (same as FFM).

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