Individual and Family Online Application

Short Term Enrollment Application

:: Application Requirements ::
Thank you for your interest in Blue Cross of Idaho's short term products.
To complete this application you will need to know the following:
  • Bank information for Automatic Monthly Bank Deduction or Credit Card information.
  • You must have a valid email address.
  • You must be an Idaho resident.
  • You must be able to answer 'No' to the following questions:
    1. Has anyone listed on this application been refused health insurance coverage or offered coverage under the Idaho State Mandated High-risk Pool plans within the last 12 months?
    2. Does anyone listed on this application currently have other health insurance coverage, Medicare, or Medicaid that will remain in force beyond the effective date of this coverage?
    3. Are you, your spouse, or any eligible dependent, whether or not listed on this application, now pregnant?
    4. Is anyone listed on this application currently admitted to a health care facility, or has surgery or other inpatient treatment been planned (but not yet performed) for anyone listed on this application?
    5. Has anyone listed on this application had a short term policy within the past 63 days with Blue Cross of Idaho?

This application consists of the 9 parts listed below and will take approximately 10-15 minutes to complete.
  1. Initial eligibility questions
  2. Applicant information
  3. Benefit period or term of coverage
  4. Smoker/nonsmoker determination
  5. Family/dependent information
  6. Replacement of coverage
  7. Payment information
  8. Application summary and confirmation
  9. Statement of understanding/applicant agreement