Individual Short Term Medical PLUS Forms

State Availability
AK, AR, CO, DC, DE, FL, GA, IA, IL, IN, MD, MI, MO, NC, NE, NM, NV, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA, WV, WI, and WY.

Note:  All applications must be presented to applicant with corresponding sales brochure which contains important directions and information pertinent to the plan and plan administration.

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