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Below form is for California only

(877)566-5454 Toll Free

Between jobs? Just graduated? Waiting for permanent coverage?

Fill in this form to have your Brochure with Pricing & Application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 1-877-Look4Life (1-877-566-5454).

Customer Information
Full Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX

Coverage Requested
Our Ages	My Age       Spouses Age
People Covered	-- Please Select -- Me Only Me and 1 Child Me and Children Me and Spouse Family
Short Term PPO	Number of days 30 days 31 days 32 days 33 days 34 days 35 days 36 days 37 days 38 days 39 days 40 days 41 days 42 days 43 days 44 days 45 days 46 days 47 days 48 days 49 days 50 days 51 days 52 days 53 days 54 days 55 days 56 days 57 days 58 days 59 days 60 days 61 days 62 days 63 days 64 days 65 days 66 days 67 days 68 days 69 days 70 days 71 days 72 days 73 days 74 days 75 days 76 days 77 days 78 days 79 days 80 days 81 days 82 days 83 days 84 days 85 days 86 days 87 days 88 days 89 days 90 days 91 days 92 days 93 days 94 days 95 days 96 days 97 days 98 days 99 days 100 days 101 days 102 days 103 days 104 days 105 days 106 days 107 days 108 days 109 days 110 days 111 days 112 days 113 days 114 days 115 days 116 days 117 days 118 days 119 days 120 days 121 days 122 days 123 days 124 days 125 days 126 days 127 days 128 days 129 days 130 days 131 days 132 days 133 days 134 days 135 days 136 days 137 days 138 days 139 days 140 days 141 days 142 days 143 days 144 days 145 days 146 days 147 days 148 days 149 days 150 days 151 days 152 days 153 days 154 days 155 days 156 days 157 days 158 days 159 days 160 days 161 days 162 days 163 days 164 days 165 days 166 days 167 days 168 days 169 days 170 days 171 days 172 days 173 days 174 days 175 days 176 days 177 days 178 days 179 days 180 days

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NEW PPO SHORT-TERM PLANS!

20% copay Doctor Visits $10 generic, $30 brand-name Prescription Drug Benefit Minimum 30 days to maximum of 185 days This means that you pay 20% of Doctor Visits, Professional Services and Hospital after the Deductible has been met up to $3,000,000 per member. Plan pays 100% in-network for covered benefits after member pays $1000 plus the deductible. Full Premium (no payment plan available) Choose from $250, $500, $1000 or $2000 Deductible Plans

A PPO (or Preferred Provider Organization) is a health plan with a list of authorized doctors and hospitals. PPO's pay well if a patient is treated by a doctor or hospital on the authorized list. One usually has many potential choices of doctor and hospital with these plans. PPO doctors and hospitals have an incentive to "over treat" patients because the more medical procedures they perform, the more money they make.

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Download Your Anthem Blue Cross Short Term Health Brochure Here