WPS Health Insurance

Hello valued WPS agents,
if you need assistance, please call:

1-888-915-5061

Individual Applications for WPS Agent Use

Name & Form Number Description
Individual Policy Application
25062-051-1401
Product-specific supplemental application for Individual Preferred Plan and Individual HSA-HDHP.
Online application for Individual Preferred Plan and Individual HSA-Qualified HDHP
Individual Policy Change Application
19348-051-1404
Application for changing an existing Individual Preferred Plan or Individual HSA-Qualified HDHP
WPS Alternative Choice Application and Payment Authorization Form
25951-021-1402
Application for enrollment to the short-term health insurance product. Payment authorization form included inside the brochure.

Medicare Supplement

Name & Form Number Description

Medicare Companion Application Form
Go to Medicare Supplement enrollment application

Online application for the Medicare Supplement Plan.
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