WPS Health Insurance

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

888-915-5061

Individual Applications for WPS Agent Use

Name & Form Number Description
2018 Individual Policy Application
25062-051-1801
Product-specific supplemental application for Individual Preferred Plan and Individual HSA-HDHP.
Online application for Individual Preferred Plan and Individual HSA-Qualified HDHP
2018 WPS-Delta-Arise Individual Policy Change Application
19348-051-1801
Application to be filled out by individuals making a change to a current policy.
2017 Individual Policy Application
25062-051-1607
Product-specific supplemental application for Individual Preferred Plan and Individual HSA-HDHP.
Online application for Individual Preferred Plan and Individual HSA-Qualified HDHP
2017 WPS-Delta-Arise Individual Policy Change Application
19348-051-1612
Application to be filled out by individuals making a change to a current policy.