Plan Enrollment . . .

Your membership becomes effective the date your application & payment are received in our corporate office.

Annual Payment Option : This option allows you to pay your entire premium once per year in one lump sum. 

1200 Plan  Single Couple  Family of 3 or 4 Family of 5+
$60 $120  $144   $180

Monthly Payment Option: This option allows you to pay your premiums monthly by having them automatically deducted from your checking account. This is a popular alternative because it saves you up to $24 per year on the cost of your premiums. To choose this option, simply download and fill out the Authorization for Checking Account Debit form. 

1200 Plan Single Couple Family of 3 or 4 Family of 5+
$5 $10 $12 $15
              

To Enroll:

  • Select an available provider office from our Doctors page

  • Download and fill out the Enrollment Application

  • Return your application with a check or money order for the appropriate premium amount, plus a one-time $10.00 enrollment fee, if paying monthly please include a bank voided check and the Authorization for Checking Account Debit form.

 

Please contact (661) 397-5513 for enrollment forms

Grievance Form