View or download an application online. NE CHIP Application Form CHIP Claim Form Deductible Change Request Form Address Change Form Health Savings Account (HSA) Request Form Authorization for Release of Protected Health Information Debit Authorization

Request an application packet by mail.

Please call me.

Email a question to NECHIP.

I am an Agent/Insurance Broker. Please send me more information.

NEBRASKA COMPREHENSIVE HEALTH INSURANCE POOL
Local: 402-343-3574
Toll Free: 1-877-348-4304
8:00 am to 4:30 pm Monday through Friday

Fax Number: 402-398-3640

Please send all premium payments to:

• Blue Cross Blue Shield of Nebraska
• ATTN: CHIP
• PO Box 3248
• Omaha, NE 68180-0001

NE CHIP Program, a comprehensive health insurance pool, online services include links to government and nonprofit health organizations, premium rate calculator and eligibility information.