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MemberAgeRangeMarketing

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All fields required unless marked 'Optional'

First Name

Please provide your first name

Last Name

Please provide your last name

Date of Birth

Please provide your date of birth

Sex Assigned at Birth

Male
Female

Please select sex assigned at birth

State (Select DC for District of Columbia if you have a true foreign address)

State is required

Select an Insurance Plan:

Select a plan to continue

Personal Email Address

You must supply a valid email address

Select Your Agency:

Select your Agency

Is this your first overseas assignment?

Yes
No

A valid answer must be supplied.

Would you like to add family members to your coverage? (Optional)

Spouse/Domestic Partner

Dependent Children

Children must be 25 years or younger.

Spouse/Domestic Partner (DP) Information

First Name

Enter your spouse's first name

Middle Initial

Last Name

Enter your spouse's last name

Sex Assigned at Birth

Male
Female

Please select sex assigned at birth

Date of Birth

Date of birth is required

Sorry! Your age exceeds the plan requirements for the coverage selected. Contact us at 1-202-833-4910 , weekdays from 8:30am - 5:30pm (EST)

Online enrollment is not available at this time. Click ‘Download AD&D Application’ to print and mail your completed form.
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Online enrollment is not available at this time. Click ‘Download IBP Application’ to print and mail your completed form.
Download IBP Application

Sorry! Your age exceeds the plan requirements for the coverage selected. Contact us at 1-202-833-4910 , weekdays from 8:30am - 5:30pm (EST)

Sorry! Based on your state residence, this coverage is currently not available.

Contact us at 1-202-833-4910 , weekdays from 8:30am - 5:30pm (EST)

{SpouseFirstName} exceeds the age limit required for coverage. Update your family selection above to continue. Contact us today for additional help at 1-202-833-4910

*If you are not a direct hire active duty employee of one of the agencies listed, please contact AFSPA at 202-833-4910 or ibp@afspa.org.

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