Current SEANC members may use the forms and links below to sign up for our insurance products. If you are not a member, you will need to Join SEANC before purchasing any of our insurance policies. To learn more about all of the insurance policies that SEANC has to offer, please visit our Insurance Products page. You can also view a PDF copy of our Insurance Brochure.
Many of the forms below are fillable PDF forms. In order to complete them, you may require Adobe Acrobat Reader. You can find it here if you need to install it.
When you have completed your application(s) and have made sure that you have saved your changes, you may upload them HERE, or print and fax them to our office at (800) 296-4999.
If you have questions about any part of this process, please review the Help Section below.
Your information will be transmitted securely to SEANC through encrypted channels.
You may choose to upload more than one application at a time. Only PDF files are allowed, please do not use this upload for anything other than SEANC insurance applications.
How Do I..
Download a form?
Most of the forms linked here are created as fillable PDFs. When you click on the "Download Enrollment Form" link for the plan you're interested in, it may do one of two things depending on your browser settings:
- Download the form
- Open the form in a new browser window
If it downloads the form, you're ready to go. Otherwise, if it opens in a new browser window, you should save the file to your desktop. How this is done depends on your browser but in general you can right-click on the document and choose "Save" or "Save As...". You can also use Control+S (Windows) or ⌘+S (Mac) on your keyboard to bring up a Save menu.
A few of the plans aren't linked to downloadable forms but instead are links to the provider's website. The links for these say "View Enrollment Website" instead of "Download Enrollment Form." Follow the directions on the provider's website to complete your enrollment.
Fill in the form?
Once you have downloaded the form, filling it in requires either Adobe Reader (available as a free download here) or a compatible PDF reader. Most browsers unfortunately do not support filling in PDF forms, which is why we advise saving the form first.
Once you have the form open you can fill it in by clicking on the text boxes to add text; and clicking on any check/radio buttons to make selections as needed.
When you've finished filling out the form, be sure to save! Once you've done so, upload the file using the upload form on this webpage.
If you prefer, you can also print out the form and fill it out with a black pen; you will need to scan the form as a PDF and upload that when you are done. You can also fax the completed form to us (see fax instructions below).
Upload my filled-out form?
When you've filled out your form and saved it, you can use the upload form on this page to upload your file. To do this, follow these steps:
- Choose the PDF file or files (you can control-click to select more than one) you wish to upload
- Click the "Upload" button in the upload section
- You're done! If the upload was successful you will see a success message
Note that we only allow PDFs to be uploaded with this form.
Fax my filled-out form?
While we prefer receiving these forms via the uploader, we also accept faxed applications. To do so, simply print and fill out your form and fax it to (800) 296-4999.
If you have any other questions or need assistance, please feel free to contact us.