Individual/Family Applications

Click here for downloads of Group Insurance Applications

Apply Online, or just print the application, complete it, and fax/mail it to us for processing:

                       Questions?  T: 1.800.994.2583

1)  Permanent Health Plans

Aetna®                                     Application

Anthem Blue Cross of CA®      1) Application

                                                             2) Application HIPAA Authorization Form

                                                             3) Application Supplement (only if necessary)

                                                             Online Quote, Application, Find Dr. + Tonik

                                                             Online "Change My Coverage" Website

                                                             Change of Plan Form  

                                                 Change of Coverage Form, Underwriting

                                                             MRMIP Declination Request Form 

Blue Shield® of California        Application

                                                             Change of Coverage Form, No Underwriting

                                                             Change of Coverage Form, Underwriting

Health Net                                Application       HIPAA Form

Pacificare                                 Application-PPO 

                                                             Application-HMO                                                     

 2)  Temporary Short-Term Health Plans

Anthem Blue Cross of CA®       Application

Health Net                                        Application        Accident Claim Form

3)  Dental Plans Under Age 65

Anthem Blue Cross of CA®     Application, Dental Blue

                                                            Application, Dental Select HMO

                                                            Application, Dental PPO

Smile Saver                                    Application, Dental & Vision                                                               

4)  Medicare Supplement Plans for Seniors

Blue Shield® of California       Application, Classic Health Plans

Anthem Blue Cross of CA®     Application, Classic Health Plans

                                                            Dental Select HMO, Brochure & Application

                                                            Dental PPO, Brochure

                                                            Dental PPO, Application

Health Net                               Application

             Questions?  T: 1.800.994.2583 Toll Free in California

Note:  Blue Cross® of California, Blue Shield® of California, and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

               © Copyright 2004 Paul Shnable Insurance Services - California License #0476133