Plan Migration Portal

Additional Enrollment

Enroll as a new member — select your plan, sign the required documents, and provide payment information.

Your Info

Association

Plan Selection

Dental + Vision

Attestation

Sign MSA

Health App

Coverage Info

Payment

Step 1 of 9: Your Info

New Member Enrollment

Tell us about yourself and anyone you'd like covered.

Your Information

First Name *

Last Name *

Email *

Phone *

Date of Birth *

Social Security Number *

Gender *

malefemale

Street Address *

City *

State *

ZIP *

Enrolled by Agent/Agency *

Dependents (Optional)

Based on your dependents, your coverage tier is Single Member. On the next steps you can choose exactly who's covered on your health plan and on dental/vision — pricing will adjust to who you select.