Get Wired with Independence Blue Cross

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* First name:

* Last name:

* Date of birth (MM/DD/YYYY):

* Last 4 digits of your social security number:

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* Employer’s name:

Yes, I want to be contacted by automated text message. Message and data rates may apply. I understand that my consent is not a condition of any benefit or purchase.

By providing my phone number and/ or email address, I authorize Independence Blue Cross, LLC, and its subsidiaries and affiliates (collectively “Independence”), and my employer to contact me via email, automated text and/or phone call. I understand that my consent is not a condition of any benefit or purchase. Message and data rates may apply.

To ensure your privacy, all information will be sent via a secure connection. Independence will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law. Please see our Notice of Privacy Practices for more information.