| You may apply online with a credit card
by clicking
here or download
the application, print and mail it in with your check, money order
or credit card information.
Click here for Terms and Conditions.
Mail
your application
along with payment
information to: |
Creative
Benefit Design
P.O. Box 3025
Terre Haute, IN 47803 |
 |
Lab Testing is not available to HI, MA, MD, ND, NJ, NY, RI, or SD residents.
Hospital benefit not available to MD, VT or WV residents.
Dental Benefit is not available to VT residents.
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