Register Member

Note: Enter your name exactly as it appears on your Subscriber ID card. Once a dependent turns 18, to view eligibility, benefits, and claims, the dependent must register on the website and sign onto their account.

First Name:*

Last Name:*

Middle Initial:

Employer Name: *

HealthCare ID:*

Email Address:*

Home Phone:

Work Phone:

Birthday:*

User ID:*

Password:*

Confirm Password:*

Please select a question and provide an answer. This will be used to reset your password if it is lost.

Security Question:*

Answer:*