•	Cover Letter
•	Information Packet
•	Checklist
•	Application for Enrollment
•	Application for Premium Assistance
•	Attending Physicians Statement if you need to demonstrate uninsurability

If you have questions or need help with the application, call toll-free 1.866.636.0080.

When you have completed the application, sign and mail it to:
AccessTN
c/o BlueCross BlueShield of Tennessee, Inc.
1 Cameron Hill Circle
Chattanooga, TN 37402

Please make a copy of your completed application for your files.