Please note: 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 you apply for a Blue Shield of California plan, be sure to view the Outline of Coverage of the plan for which you are applying.  You can find the most recent Outline of Coverage pdf by running an instant quote and selecting the plan you are interested in.  Each Outline of Coverage contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage.

Apply Online:

The fastest and easiest way to get your coverage in force is to Apply Online, using the link below.  Gather the following information before you start the application in order to speed the process:

Gather the following information before you start the application in order to speed the process:

1. Your doctors’ names, addresses, and phone numbers
2. Medications you currently take or recently took, including dosage and frequency
3. Dates of hospitalization
4. The name of the plan for which you are applying
5. Your requested effective date
6. Your credit card information to cover the initial premium

Apply by Fax or Mail:

To print out your application, 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 1-866-284-0082.  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.

CA License #: 0E39302