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Individual and Family Online Application

What will I need to complete this application?
You must complete the application process before 10/8/2014. If you have not completed the application by this date, your application will be deleted and you will need to start from the beginning.
 
:: Accept Terms & Conditions ::
 

The following Terms and Conditions govern your use of the Blue Cross of Idaho on-line application. The Terms and Conditions do not replace, but are a supplement to the Legal Disclaimer on the Blue Cross of Idaho Web site. Please read the Terms and Conditions carefully so you fully understand your rights and responsibilities.


Information Collected
We may collect applicant information from you such as name, gender, address, phone number, fax number, email address, member number, date of birth, Social Security Number, health plan, treating physician(s), diagnosis, date(s) of service, treatment, prescriptions prescribed and/or any other information we need to verify who you are or to determine what information may be made available to you.


Access to Information
You will not allow any other person or user to have access to the information contained in the online application unless the person’s access is consistent with applicable state and federal laws. All passwords used to access the online application must be kept confidential. If you believe that a password has become known to someone else, contact Blue Cross of Idaho via Email or via phone at 208-387-6683 or 800-274-4018 to report the issue and obtain a new password.


Security
Information transmitted to Blue Cross of Idaho via the online application is secured with 128-bit encryption and the information communicated will not leave our private network. Although Blue Cross of Idaho has security measures in place, we cannot guarantee that unauthorized users will not gain unauthorized access to your information or otherwise misuse the system. You assume all risks associated with using the online application and release Blue Cross of Idaho from any claim, liability and/or damages, as a result of your use of the online application.


If any provision of these Terms and Conditions is determined to be invalid, all other provisions will remain in full force and effect. These Terms and Conditions shall be interpreted and enforced according to the laws of the State of Idaho.