Print this pageMail it to me
Note: Any packet that you request will be mailed to the name and address of the main subscriber on your account. If you want it mailed to another address, call Basic Health at 1-800-660-9840.
Not all forms are available for mailing.
Applications
Application for Basic Health (Instructions included) (930.1 KB)- Application for Basic Health (Spanish) (Instructions included) (575.5 KB)
English
- Address Change (433.6 KB)
- Basic Health Plus Application (304.2 KB)
- Birth or Adoption (107 KB)
- Divorce or Separation (978.9 KB)
- Family Addition (107 KB)
- Income Change (243.4 KB)
- Marriage (423.1 KB)
- Maternity (Pregnancy) Application (304.9 KB)
- Out-of-Country Spouse (21 KB)
- Permission Form (122.4 KB)
Spanish
- Basic Health Plus Application (263 KB)
- Maternity (Pregnancy) Application (325.1 KB)
- Out-of-Country Spouse (21.7 KB)
- Permission Form (117.4 KB)
