Individual Products & Forms

Rate Tables for New Individual Plans: 
Dane County, Tobacco User  |  Outside Dane, Tobacco User  
Dane County, Non-Tobacco User  |  Outside Dane, Non-Tobacco User

Sales Area by Zip Code

Plans & Riders

Member Materials 

Individual/Family Plan Choice Form

Release of Information Authorization

EFT Authorization & Change Form

Non Group Change Form ** For Changes Only.

Please use the Individual Uniform Application (above) for new enrollment.

Send the Non Group Change Form to:
Physicians Plus Insurance Corporation
2650 Novation Parkway
Madison, WI 53713