Plan Change Information
Select the plan that’s best for you

You have received a letter recently regarding changes to our Individual medically underwritten plans that will affect your monthly rates. We know that any increase in rates can be difficult, which is why we want to make it as easy as possible for you to understand the options available to you if you would like to make a change.

Your options	Need help choosing a plan?	What you need to do

Select a lower-cost option	Click on your current plan to see what lower-cost options are available for you. HMO 10 Copay HMO 15 Copay HMO 20 Copay HMO 30 Copay HMO 1500 Deductible HMO 2500 Deductible HMO 5000 Deductible PPO 30 Copay PPO 2500 Deductible PPO 5000 Deductible PPO 3000 HSA PPO 5000 HSA PPO 8000 Deductible (This plan is currently our lowest-cost individual medically underwritten plan.)	Complete the Plan Change Request Form. Mail your form to the address below or fax it to 215-238-7067 by June 4, 2012, to ensure that your invoice reflects your new premium. Mailing address: Independence Blue Cross P.O. Box 41452 Philadelphia PA 19101 Pay your invoice by the due date to receive a new ID card and benefits materials.

Removing a dependent from your policy	If you would like to remove a dependent, please complete the Plan Change Request Form. You can also use this form to select a lower-cost option.	Complete the “Remove dependents” section of the Plan Change Request Form. Mail your request to the address below, or fax it to 215-238-7067. Mailing address: Independence Blue Cross P.O. Box 41452 Philadelphia PA 19101 IBC will review your request and notify you of your new rate.

Adding a dependent to your policy	If you would like to add a dependent, please complete and submit a new application.	Complete a paper application. Mail your completed application to: Independence Blue Cross P.O. Box 41474 Philadelphia, PA 19101-1474 IBC will review your application and let you know whether the person can be added to your policy or not. If approved, we will provide you with your new rate.

If you have other questions concerning this rate adjustment, please call us at 1-888-249-2118 .

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Plan Change Information Select the plan that’s best for you

Plan Change Information
Select the plan that’s best for you