| Step |
How
to Apply for SelecTEMP |
| 1. |
View the rates for
Coverage:
Rate
Chart for SelecTEMP
|
| 1. |
Download
the application and Bank Draft Authorization. Complete all of the
required questions and information.
To Download:
The applications will be
downloaded in the PDF format (Portable Document Format) by Adobe®.
Most computers may already have the Adobe Reader® installed. If you
don't, simply go to the link below to download and install on your
computer. Once installed, download the required application form and
open in the Adobe Reader® and print the form in black ink.
Application for SelecTEMP
|
| 2. |
Include a check-payable
to Blue Cross and Blue Shield of Texas for your premium.
The total premium must be submitted with the application unless you
have chosen the Monthly Bank Draft option. The Monthly Bank Draft
option is available to the applicant who selects a 2-to 6 month
coverage period. A check for the first month of premium must
accompany the application. A blank check marked "VOID" and
Bank Draft Authorization Request Form MUST also by included with the
application. A deposit slip is not acceptable. |
| 3. |
Select an option for
future premium payments (direct bill, monthly bank draft, or list
bill). If choosing bank draft, include a blank check marked
"VOID" and submit a Bank Draft Authorization Form with
your enrollment application. Submit a check for the first months
premium with bank draft plan. |
| 4. |
Mail your application
and check to the address listed below:
Insurance-Online-Texas.com
James Stafford Insurance Agency
1562 NW Access Rd.
Mount Vernon, TX 75457
|
|
