About UsFind A ProviderCompare PricingMail Order RX

Step 1

Discount Medical Plan Application

Your Account Information
Please provide all of the following information.
Gender: Male Female
First
Initial
Last
Address:

City:
State:
Zip:
Phone (1112223333):
Email:
Birthdate (mm/dd/yyyy):
/ /
Create a Password:
(max. 16 chars.)
Verify Password:
Form: exp-03659-1

Your membership is effective upon receipt of membership materials.

This program is NOT insurance coverage, not intended to replace insurance and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR 5.00. This program contains a 30 day cancellation period. This program provides discounts at certain healthcare providers for medical services. This program does not make payments directly to the providers of medical services. The program member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. For a full list of disclosures, click here. Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475.

RSS