Application for Coverage

Download the AMCA application, complete it, and send it in using one of the methods below.

AMCA Application (PDF)

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Download PDF

Please be sure to include all pages, signatures, and any additional copies of the Health History Questionnaire (page 2) needed for each person.

Send Completed Application

Mailing Address
Anabaptist Brotherhood
P.O. Box 144
Guys Mills, PA 16327
Fax
814-529-0068
Phone
574-354-4449

Before You Send

  • Ensure each adult (18+) signs the Acknowledgements and Authorization.
  • Include a Health History Questionnaire for each person applying.
  • If you have questions about eligibility or the plan, please review the Guidelines first.
View Guidelines