Download An Application

Ready to begin the application process? Simply click below on your state of residence to
download an application. Print off the pdf form, fill it out, and mail it back to the address below. Or, you can fax it to 1-866-472-1472. If faxing, initial payment must be made by either credit card or electronic funds transfer.

Mail to:

Health Plus America
1258 Sadie Lane
Fenton, MO 63026

Fax to:

1-866-472-1472