Please note
that all applications will be submitted in the name of Wiley Long, the
president of HSA for America.
If you have already been working directly with one of our advisors, then that
person will be noted in our system as your personal contact. Before
applying for a Health Savings Account insurance plan, please read the Exclusions
and Limitations information, as well as the Enrollment Guidelines
on the brochure:
Lumenos
HSA Plan Brochure 
The
fastest and easiest way to apply for any plan with Blue
Cross Blue Shield of Ohio is to Apply
Online, using
the link above. Gather the following information before you start the
application in order to speed the process: -
Your doctors’ names, addresses, and phone numbers
-
Medications you currently take or recently took, including dosage and frequency
- Dates
of hospitalization
-
The name of the plan for which you are applying
-
Your requested effective date
-
Your credit card information to cover the initial premium
To apply
by fax or mail, just follow the instructions below:
Simply run an
instant quote, then click "Apply"
next to the plan you are interested in and select "download an application."
When the Adobe Acrobat reader opens with the application, use the menu bar at
the top to save the application to a file or simply print it out right from
the reader. Follow
the instructions on the first page and complete the entire application. Please
fill out the application completely and include all pages.
Any unanswered questions will delay the processing. If you have any questions
about filling out the application, call application processing department at
866-749-2039, or email us at info@HSAforAmerica.com,
leave your name and phone number, and someone from our office will call you
back and answer any application questions you have. Fax
your application toll-free to 1-888-771-0010. Or Mail it to:
HSA
for America
1001-A East Harmony Road, #519
Fort Collins, CO 80525
Note:
All policies come with a money-back guarantee. After receiving
your policy, you have 10 days to review it. If for any reason you decide
not to keep the policy, you will receive a full refund of your initial premium.
Remember that you also have access to the guaranteed lowest
life insurance rates available, with easy online quotes and applications.
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