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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 (352.6 KB)
- Divorce or Separation (978.9 KB)
- Family Addition (352.6 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)
