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Please enter your First Name (required).
Please enter your Last Name (required).
Please select a month and day from the drop down menus and type in a 4 digit year (required).
Please enter your Member ID (required).
Please enter your Group Number / Account Number (required).
See your ID card and enter the details exactly as shown.
Your information is kept secure at all times.
You must be
13 or older to register
All fields are required.
If you do not have your member ID card, please call the helpdesk. Click to get helpdesk information.
Name (as it appears on your ID card)
All fields are required. Name (as it appears on your ID card).
Date of Birth. Year(YYYY)
Date of Birth
What is this?
Do not include numbers after dash or space in ID (i.e. 1234567-00).
ID Card Examples
You can find your Member ID on your ID card or in your enrollment materials. If you do not have these materials, you can enter your Social Security number instead of your Member ID.
Please note, the cards below are examples only. Your card may look slightly different.
Medical ID Card Example
Dental ID Card Example
What if I don't have my ID card?
What if the system can't find my information?
How do I register?
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Legal Entity Information
Today's Date: April 4, 2020
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