Mississippi Comprehensive Health Insurance Risk Pool Association

In order to apply, click below and download and print the Application for Coverage.

Read all questions carefully and answer all questions completely.
DO NOT complete Page 5, unless you are eligible for immediate coverage. If you complete Page 5, you must include the Required Documentation.
Be sure to sign and date appropriate pages of application and have your signature witnessed by a third party.
Include Proof of Residency and a voided check.
Mail application to Blue Cross and Blue Shield. The address is shown at the bottom of Page 6 of the Application for Coverage.
DO NOT attempt to send application via email, as this is not a secure web site.


Home Eligibility Coverage Exclusions Prices Application FAQ Contact Links Pharmacy	Application In order to apply, click below and download and print the Application for Coverage. Read all questions carefully and answer all questions completely. DO NOT complete Page 5, unless you are eligible for immediate coverage. If you complete Page 5, you must include the Required Documentation. Be sure to sign and date appropriate pages of application and have your signature witnessed by a third party. Include Proof of Residency and a voided check. Mail application to Blue Cross and Blue Shield. The address is shown at the bottom of Page 6 of the Application for Coverage. DO NOT attempt to send application via email, as this is not a secure web site. Click here to download the Application for Coverage.