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Sign Up with TelAssurance
Your first step to wellness starts here.
1. Personal Details
Enter your personal details and contact information.
FIRST NAME
*
MIDDLE NAME
LAST NAME
*
DOB (M/D/YYYY)
*
GENDER
*
Select a gender
PHONE NUMBER
*
EMAIL ADDRESS
*
ADDRESS 1
*
ADDRESS 2
CITY
*
STATE
*
Select a state
ZIP CODE
*
Save & Continue
2. Add Dependents
Add additional family members to your plan, including a spouse and child dependents up to age 30.
No dependents.
New Dependent
Relationship to Primary Member
*
Select a relationship
FIRST NAME
*
MIDDLE NAME
LAST NAME
*
DOB (M/D/YYYY)
*
GENDER
*
Select a gender
PHONE NUMBER
*
EMAIL ADDRESS
*
Dependents under the age of 18 will be registered under the primary member's account.
Maximum age for dependents is 30.
Add Dependent
Cancel
Save & Continue
3. Confirmation & Payment
Edit Additional Members
No dependents.
Individual Retail Membership
Membership Start Date
9/16/2024
First Bill - 9/16/24
--
Recurring Bill - from 10/16/24
--
/ month
One time $25 signup fee.
Payment processing fees will apply.
Please check
territory map
for eligibility.
One time $25 signup fee. Payment processing fees will apply. Please check
territory map
for eligibility.
On behalf of each member in this membership:
I authorize TelAssurance to send email or text which may include unencrypted protected health information.
I have read and agree to the TelAssurance Individual Membership Policies.
*
By submitting your account information, you authorize TelAssurance to electronically debit and credit your account on a recurring basis as set forth in your membership agreement or as displayed to you during the signup process. You understand you can contact TelAssurance to revoke this authorization at any time.
Our billing partner
Hint Health
uses state-of-the-art data encryption technology and is regularly audited against comprehensive
security and compliance
frameworks.
Confirm & Create Account
