Online Application How to help your customers apply

Through ROAM, you can generate an email to a prospective applicant. This email includes a link, embedded with your broker code, to the ibx4you.com website.
Applicants must have cookies enabled before clicking the link with your broker code and keep cookies enabled until they complete the registration process. This allows us to track their application to you.
Applicants should complete all sections of the application and be sure to include dates and relevant details for medical conditions, medications, and physician visits for all persons being covered.
Applicants will need to read, electronically sign, and date the Declarations and Conditions of Enrollment section of the application.
Section O of the application, which requires information on the broker of record, will be filled in with your information when you send the link through ROAM.
Applicants applying to waive the preexisting condition clause through a Blue-to-Blue transfer or other creditable coverage must complete all parts of Section G (Other Insurance) and submit a Certificate of Creditable Coverage for each qualifying individual to be covered by the plan.
Applicants will need to read, electronically sign, and date the Authorization for Release of Medical Information.
Important: If you are going to complete and submit the online application for your client, you are now required to provide proof of consent on behalf of the applicant. The applicant must sign an Authorization to Submit Application Online Form. Return this form, along with the original enrollment application, within 24 hours to: