- 2024 Individual Health Plan Application Checklist
Use this checklist to make sure your 2024 application is complete and correct. - 2024 Individual Health Plan Application/Change in Coverage (Off Exchange)
Use this form to apply for a BCBSMT Individual Health Plan (Off Exchange) effective January 1, 2024, or to submit a change in coverage. For individuals under age 65. - 2024 Individual Health Plan Application/Change in Coverage Additional Dependents Form
If you run out of room on the primary application for health plan coverage, use this form to add more dependents to your policy. Use this form for plans effective January 1, 2024. - 2024 Individual Dental Plan Application/Change in Coverage
Use this form to apply for a BCBSMT Individual Dental Plan effective January 1, 2024, or to submit a change in coverage. - 2024 Small Group Enrollment Application/Change Form
- Use this form to apply for small group coverage effective January 1, 2024.
- 2024 Large Group Enrollment Application/Change Form
Use this form to apply for large group coverage effective January 1, 2024. - Individual Plan Responsible Party Form (Child-Only Policy)
Please fill out this form if you have applied for a child-only policy but did not specify the policy owner. Use this form to tell BCBSMT that you will be the responsible party/policy owner for the child-only policy. - Application for Medicare Supplement Insurance Plan
Those who are eligible for Medicare can use this form to apply for BCBSMT insurance that will supplement their Medicare coverage.