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Health Insurance in Idaho
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Individual and Family Online Application
Please provide us the information requested below, e.g., name and address.
For questions, please contact a sales representative at your local district office (800) 365-2345.
:: Applicant Information ::
* required field.
Social Security Number
Why do we need this?
Mailing Address (street or route)
Is your billing address the same as your mailing address?
Home Phone No.
Work Phone No.
Other Coverage Information
Is this person now covered, or has he or she been covered by any other dental insurance?
Is this person now covered by a medical health insurance policy?
We request your Social Security number on this application because federal law requires all health insurers to report specific group and member information to the Center for Medicare & Medicaid Services (CMS). This includes the Social Security number for members and their dependants.
Blue Cross of Idaho has adopted policies, procedures and practices to safeguard the security and confidentiality of personal information including Social Security numbers.
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Affirmative Statement about Incentives
An Independent Licensee of the Blue Cross and Blue Shield Association.