First, both you and your spouse (if applying) need to become JACL members.  Complete the JACL Membership application and make your check payable to: "JACL".  If you are already a current JACL member, please indicate your chapter name on the Blue Shield application.

Next, you'll need to choose one of our four plans:

• PPO…………...(includes Dental and Vision)

• HMO……….…(includes Dental and Vision)

• Basic PPO….…(no Dental/no Vision)

• Active Choice....(no Dental/no Vision)

- If you are applying for our HMO plan, then you should choose a Blue Shield HMO Personal Physician for yourself and each family member, otherwise Blue Shield will select one for you.  If you have questions in choosing a physician, please call 1-800-424-6521 or click here.

- If you are age 55 and over, you need to provide specific information regarding a complete physical examination performed within the last two (2) years.

If your application is approved by Blue Shield of California, then you will be notified of the effective date and billed. Incomplete or illegible applications are returned, so be sure to carefully review the entire form and print clearly in ink (or type). Don't forget to sign your application.