If you have a BlueChoice for Kids, BlueChoice for Young Adults or MyChoice Individual Health Coverage policy, you can use the Individual Change Request Form to:

• Cancel your plan on the next due date
• Change your address
• Add/change your bank draft

Print and complete the form. Send the form to us using the instructions at the bottom.

If you have coverage through a group plan, contact your employer to make these changes.

Please note: Your policy will be cancelled at the end of the month in which you made the request.