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