Forms

Simply download the form based on the state where you live, complete, sign, and mail or fax to the address or phone number listed below.

AveraAdvantage Service Forms

• Authorized Representative
• Change Notice
  
  Must use Overnight mail address:
          AveraAdvantage
          P.O.  Box 391885
          Cambridge, MA 02139
• Claim Form
• Enrollment Application

AveraAdvantage members live in these states:

• South Dakota and Nebraska

Service Mailing Address

AveraAdvantage

P.O. Box 742528

Houston, TX 77274