Member Information Form

Dear Member:

Your association sponsors a health, dental and vision plan through BlueCross BlueShield of Alabama.

To begin the enrollment process, complete the below information and click the Submit button. 90 Degree Benefits will be acting as the enrollment manager for the association plans. The information you provide below will allow 90 Degree Benefits to create a personalized username and password that will be sent to the email you provide below. This username and password will allow you to enter the enrollment system to complete your enrollment in the new association plans.

Marital Status