Get Application For Personal Bluesm

Filling out the APPLICATION FOR PERSONAL BLUESM online is a straightforward process that allows users to apply for personal blue coverage efficiently. This guide provides a detailed walkthrough of each section, ensuring you complete the form accurately and confidently.

Follow the steps to complete your application smoothly.

1. Click the ‘Get Form’ button to access the application form and open it in the online editor.
2. Start with PART ONE, SECTION A - APPLICANT INFORMATION. Fill in your first name, last name, and middle initial. Enter your date of birth, social security number, telephone number, and email address accurately.
3. Indicate your requested effective date, ensuring it is either the 1st or the 15th of the month. Confirm residency in South Carolina, as only residents are eligible for coverage.
4. Continue with your street address, city, state, and ZIP code. If your billing address for premium notices is different, fill in the appropriate details in the designated section.
5. Move on to SECTION B – COVERAGE INFORMATION. Select your Personal BluePlanSM options, including the desired plan and coinsurance options, as well as deductible and out-of-pocket maximums.
6. Complete the banking information section, choosing between monthly bank draft, monthly direct bill, or monthly credit card options. Attach any required documentation like a voided check.
7. In PART TWO, SECTION A - HEALTH HISTORY, accurately record your height, weight, and any recent weight change. Respond to the health-related questions as thoroughly as possible.
8. Proceed to SECTION C - OTHER INSURANCE INFORMATION, disclosing any past health insurance coverage and ensuring to answer all questions.
9. In PART THREE, SECTION A - AUTHORIZATION AND AGREEMENTS, read carefully before signing. Confirm your understanding and agreement by providing your signature, and date the application.
10. Finally, review all information provided for accuracy. After ensuring everything is correct, save your changes. You may download, print, or share the completed form as needed.

Start your application process online today to ensure you get the coverage you need.