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.
You
must fill out an application and submit it along with
the first month's payment by either check or authorization of a credit card.
Both the document and the payment must be submitted in tandem. It is necessary
for all applicants to fill out the medical questionnaire before any coverage
is offered.
In
order to be eligible for coverage by BCBS of VA, applicants must reside in a
designated service area. The BCBS of VA service area covers the entire
state except for a few minor exceptions:
- City
of Fairfax
- Town
of Vienna
- Areas East
of State Route 123
The
specific date that applicant's coverage begins is determined by the date of
the signed application. The effective date must be set within 90 days of
the applicant's signature date. The earliest effective date for any applicant
can be the day the application was signed, but in order to receive the desired
effective date, Anthem must receive the application within 10 days of the signature
date. If in some case the application does not have a specified effective date,
then the day that Anthem approves the application is the default effective date.
For specific
eligibility requirements for specific types of coverage, including conditions
applying to dependents, minor children, group coverage, military service, etc.,
please read the Exclusions and Limitations information, as well as the
Enrollment Guidelines on the brochure:
Lumenos
HSA Brochure 
- KeyCare
HSA and HeartSmart Brochure
Any
insurable risk determination is acquired through the application, medical forms,
and health underwriting to determine the medical history and current health
of any applicant to determine appropriate risk levels. All final decisions regarding
the applicant's insurable risk are made by Anthem. Alternate underwriting decisions
are offered by Anthem to any applicant that plans to choose a policy with a
$5,000 or greater annual deductible. Medication denials apply.
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.
