HEALTHPERX PREMIUM
HealthPerx PREMIUM Discount Plan Application
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Discount Plan Application - By submitting this form, I acknowledge receipt and acceptance of the disclosures listed below.
Not available for UT, VT, or WA residents
Your welcome email will be sent to the email address you used to sign up within 24-48 hours, from [email protected] that will include your member ID, group ID, and instructions on how to register and your membership and begin using your benefits. You can start using benefits digitally by MyBenefitsWork app and web portal right away. Printed membership kits will arrive in approximately 10 business days. If you don’t receive the email, check your junk folder.
If you have any questions regarding this order, please reference your order number and send an email to [email protected] or call 800-800-7616, Monday-Friday, 7:00am to 7:00pm and Saturday 8:00am to 5:00pm Central Time.
Please allow a minimum of 24-48 hours to become eligible with corresponding benefits before attempting to use your membership. We look forward to serving you.
Your membership is effective upon receipt of membership materials.
The discount program provides access to the Aetna Dental Access® network, which is administered by Aetna Life Insurance Company (ALIC). ALIC does not offer or administer the discount program, and is not an affiliate, agent or principal of the discount program. Dental providers are independent contractors and not employees or agents of ALIC. ALIC does not provide dental care or treatment and is not responsible for outcomes.
This program is NOT insurance coverage 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. Member shall receive a reimbursement of all periodic membership fees if membership is cancelled within the first 30 days after the effective date. Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475.
Not available to UT, VT or WA residents.
Lab benefit not available in MD, NJ, NY or RI.
Iowa Notice of Cancellation (audio file)
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