4200 Mapleshade Ln, Suite 200, Plano, TX 75093-2026

1. Click ‘Get Form’ to open the application in the editor.
2. Begin by filling out the 'Applicant Information' section. Ensure you provide your last name, first name, and middle initial clearly. Include your address both inside and outside the U.S., along with contact numbers.
3. In 'Time and Location Status', indicate how much time you will spend outside your home country in the next year and specify locations.
4. Complete the 'Choice of Plan' section by selecting your desired coverage plan.
5. For 'Applicants for Coverage', accurately list all family members applying for coverage, including their relationship to you, gender, height, weight, date of birth, and social security or passport numbers.
6. Answer all questions in the 'Health History' section thoroughly. If any question is answered 'Yes', provide detailed information in Section 6B.
7. Review all sections for completeness before submitting. Ensure that all required signatures are included at the end of the application.

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