Individual Applications for WPS Agent Use

Name & Form Number	Description
WI OCI Individual Uniform Application Form OCI 26-503 (c. 06/2010)	Health and personal information questionnaire. Must be submitted along with the respective product-specific Supplemental Application for a complete application
Individual Policy Supplemental Application 25062-051-1211	Product-specific supplemental application for Individual Preferred Plan and Individual HSA-HDHP. Must be submitted with the WI OCI Individual Uniform Application Form (OCI 26-503 (c. 06/2010)) or the application will not be processed
Individual Policy Change Application 19348-051-1211	Application for changing an existing Individual Preferred Plan or Individual HSA-Qualified HDHP
Individual Policy Online Application PPO/HDHP online application	Online application for Individual Preferred Plan and Individual HSA-Qualified HDHP
Instant Protection Plan Brochure, Application, and Payment Authorization Form 25315-021-1302	Overview and benefits summary for short-term health insurance product. Application and payment authorization form included inside brochure.
Instant Protection Plan Online Application IPP online application	Online application for Instant Protection Plan