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
2016 Individual Policy Application
25062-051-1601
Product-specific supplemental application for Individual Preferred Plan and Individual HSA-HDHP.
Online application for Individual Preferred Plan and Individual HSA-Qualified HDHP
2016 Individual Policy Change Application
19348-051-1601
Application for changing an existing Individual Preferred Plan or Individual HSA-Qualified HDHP
2016 WPS/Arise Individual Medically Underwritten Policy Change Application
27675-051-1502
Application for changing an existing grandfathered, medically underwritten Individual Preferred Plan or Individual HSA-Qualified HDHP

Medicare Supplement

Name & Form Number Description

Medicare Companion Application Form
Go to Medicare Supplement enrollment application

Online application for the Medicare Supplement Plan.