Price Associates Insurance Services, Inc.
Providing Exemplary Service to Agents for Over 30 years.
Blue Cross Senior Downloads
click on the to download file
Applications & Forms Form # Effective
Monthly Checking Account Deduction Authorization for Seniors  IS2028  05/05
SELECT & SELECT PLUS Stand-Alone Application  IS2237  02/04
Benefits & Guides Form # Effective
Advantage Care Rates  5122  03/08
All-Product Mini Brochure  5792  02/07
Classic Rates  IS9147  03/08
Life Benefits - Final Expense Replacement of Coverage Form  1415  01/01
LifeBenefits Brochure and Application  1418  03/06
Long Term Care - Sales Kit Request Sheet  NA  01/06
Pre-65 Plan Rates  IS2432  03/08
SELECT & SELECT PLUS Stand-Alone Rate Sheet  IM2137  12/05
SmartChoice Rates  7020  03/08
Dental Form # Effective
Dental PPO Stand-Alone Application  8158  01/05
Dental SelectHMO Stand-Alone Application  8867  04/03
Medicare Form # Effective
AdvantageCare Brochure  5121  12/06
AdvantageCare Stand-Alone Application  5123  02/07
AdvantageCare Stand-Rate Sheet  5122  01/07
Medicare Part D Conditions and Limitations  NA  09/06
Medicare SELECT Hospital List (All Areas)  5405  08/05
MedicareRx Application - 2007  11712CA  09/06
MedicareRx Gold Plan  11735  10/06
MedicareRx Plan Comparison Chart  NA  09/06
MedicareRx Summary of Benefits  11711CA  09/06
MedicareRx Value & Plus Plans  11739  10/06
Pre 65 - Plans Brochure  IS7023  01/07
Pre 65 - Plans Stand-Alone Application  IS2431  02/07
Pre 65 - Plans Stand-Alone Rate Sheet  IS2432  01/07
Senior Classic Brochure  IS7067  01/07
Senior Classic Stand-Alone Application  IS2238  01/07
Senior Classic Stand-Alone Rate Sheet  IS9147  01/07
Senior SmartChoice Brochure  7018  01/07
Senior SmartChoice Stand-Alone Application  7019  02/07
Senior SmartChoice Stand-Alone Rate Sheet  7020  01/07
Freedom Blue Form # Effective
Benefit Summary Sheet  12407R  10/06
Comprehensive Drug Formulary  13181  04/07
Freedom Blue Application  11678CA  07/06
Freedom Blue Product Brochure  11669  01/07
Freedom Blue Summary of Benefits  11670  01/07
SmartValue Form # Effective
Comprehensive Drug Formulary-Enhanced Plus  11738  04/07
Comprehensive Drug Formulary-Plus  11736  04/07
SmartValue - Application  8660CA  07/06
SmartValue - Benefit Summary Sheet  12407P  09/06
SmartValue - Summary of Benefits  8664CA  11/06
SmartValue Product Brochure  8663CA  10/06
Friday, May 09 2008 
License: 0596691
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