Application Form for our Individual Health & Dental Plans

We are pleased to provide an application form for our Individual Health & Dental Plans.

For your convenience, there is also a worksheet showing you all of our different plan options and their rates to help you choose.

Refer to your plan text for details and explanations of terms.

Contact Individual Plans

Monday to Friday
8:00am to 4:30pm

If you would like to talk to one of our individual plan representatives:

Within the Lower Mainland

604 419-2200

Toll-free outside Metro Vancouver

1 800 873-2583

Mailing address & fax

Pacific Blue Cross
PO Box 7000
Vancouver, BC
V6B 4E1 Canada

Fax: 604 419-2199