Member Forms
You can download the online forms in pdf format by clicking on the headlines below.
- Application to Continue Coverage for a Disabled Dependent Child
Disabled dependents may be eligible to continue on the policy if proof of eligibility is met. To apply for disabled dependent coverage, complete and return the form to one of the following:
IBCMembershipDisabilityApplication@ibx.com
Independence Blue Cross
c/o Enrollment Services
1901 Market Street
Philadelphia, PA 19103