Individual and Family Plan Applications

Please note: TruAssure cannot accept applications for individual insurance plans via fax or email. All applications must be mailed to TruAssure at the following address: TruAssure, Consumer Direct – Individual, PO Box 804307, Chicago, IL 60680-4104.
 

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Por favor, note: TruAssure no puede aceptar solicitudes de planes de seguro individual por fax o correo electrónico. Todas las solicitudes deben ser enviadas a TruAssure a la siguiente dirección: TruAssure, Consumer Direct – Individual, PO Box 804307, Chicago, IL 60680-4104.

TruAssure Group Plan Forms

(Note: this is the application required by Wisconsin for employees of groups of 2-50 employees. This link will direct you to the Wisconsin Office of the Commissioner of Insurance (OCI) website.)

(Note: Please use TruAssure’s Group Member Enrollment Form for employees of groups with 51 or more eligible employees.)

(Note: Please use TruAssure’s Group Member Enrollment Form for employees of groups with 51 or more eligible employees.)

Other Forms

To complete with a digital signature and send electronically, please download this form with Adobe or another PDF reader.

Para completar con una firma digital y enviar electrónicamente, por favor descargue esta forma por el Adobe u otro lector PDF.