Your health insurance plan is just a click away!

Download the form by clicking on the following links and send it to us after you have completed the form.

1. Temporary health insurance
2. Temporary health insurance (Maryland only)
3. Affordable health insurance for college students
   
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• If you are paying by credit card fax the completed form to (301)299-0976.
  
  
• If you are paying with check mail the completed form to:

  11208 Korman Drive
  Potomac, MD 20854

If you have any questions call us at (301)299-4800.