For information on individual/family health insurance coverage options, please call (877) 444-2583 to talk with an individual/family health coverage specialist. You can also submit the form below, and we will respond to you by either phone, e-mail, or mail, whichever you prefer. ( * denotes required fields).

Note: Individual products offered by Blue Cross and Blue Shield of Nebraska are available to Nebraska residents only.

If you are a member or health care coverage applicant, please use the general inquiry form or call (402) 390-1820 or (800) 642-8980.

*Your First Name:
*Your Last Name:
Your Phone Number:  ext

Your Email Address:
YOUR POSTAL MAIL ADDRESS  
*Address  
*City:

 
*State:

 
*ZIP:  
*Response Method:



ADDITIONAL INFORMATION  
*Date of Birth:
*Gender:

Work Phone Number:  ext
*I'm interested in:




Individual dental coverage is not offered at this time.