MEMBER INFO

When prompted, use the email address associated with your JustAnswer membership. Discount Plan Application

Primary Member

* First Name

* Last Name

* Gender

* Date of Birth (mm/dd/yyyy)

Agent Name

* - required

Form #NB-nb9297q

Your membership is effective upon receipt of membership materials.

This program is NOT insurance coverage, not intended to replace insurance 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. This program provides discounts at certain healthcare providers for medical services. This program does not make payments directly to the providers of medical services. The program member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. For a full list of disclosures, click here. Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475.

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