Member Registration

Enter your name exactly as it appears on your Subscriber ID card. To view your dependent(s) over the age of 18, each of your dependents will need to register in the Dependent Registration section. Once your dependents have registered, they must sign the Designation of Authorized Representative form found in the Resource Center of the Member Portal.

I am a

Register as a Member

First Name: *
Last Name: *
Middle Initial:  
Employer Name: *
Health Care ID: *
(Example: 333-12345 Exclude any alpha characters.)
Email Address: *    
Home Phone: *
Work Phone:  
Birthday: * Month: Day: Year:
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.
Question: *  
Answer: *