Membership includes you and your immediate family. Primary member card and second card included in base price. All members have access to benefits using these two cards.
Additional dependent cards with printed names incur a one-time charge of $1 per card. Please input dependent's names in this area. First dependent name included in base price. If no dependent is indicated member receives two cards in primary members name.
Thank you for signing up for the Health Assure Plan. By signing up you agree to pay a one-time set-up fee of $5.00 and a monthly fee of $14.95.
By submitting this form, I acknowledge receipt and acceptance of the disclosures listed below.
Total billed today: $19.95
Your membership is effective upon receipt of membership materials.
This program is NOT insurance coverage,