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Yes No or abnormality of the immune system or tested positive 12 months If yes who for HIV or HTLV. Indiana Blue AccessSM/Blue Traditional Lead Source Application Please complete application in blue or black ink. Yes No systemic lupus erythematosus sclerodema herniated disc Have you or any dependent been seen by any physician in back pain or disorder of the muscles or bones including the past 6 months. Yes No e. Sugar or albumin in the urine stones or other disorders of the kidney bladder...
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To fill out Indiana Blue Access Blue Traditional, follow these steps:
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Visit the Indiana Blue Access Blue Traditional website.
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Indiana Blue AccessSM Blue Traditional is a health insurance plan offered by Anthem Blue Cross Blue Shield in Indiana.
Individuals or families looking for health insurance coverage in Indiana may choose to enroll in Indiana Blue AccessSM Blue Traditional.
To enroll in Indiana Blue AccessSM Blue Traditional, individuals can visit the Anthem Blue Cross Blue Shield website or contact their customer service for assistance.
The purpose of Indiana Blue AccessSM Blue Traditional is to provide health insurance coverage to individuals and families in Indiana.
Information such as personal details, medical history, and coverage preferences must be reported when enrolling in Indiana Blue AccessSM Blue Traditional.
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