Personalize your benefits today!

Cart (0) $0.00

GROUP APPLICATION

Information Saved !!
Please enter email you want to send registration link to?


  

Broker Information


Group Information


Group Contact Information


Group/Admin Login Information

Minimum 8 characters, at least one letter, one number & one special character

Group Address


Continue without Address Validation

Billing Address & Contact Information

Check this box if Employer/Group Address are the same.

Continue without Address Validation

Payment Information

What is Routing Number ?Click here !

Group Contribution


Signature & Verification

UBHKP

 


Access to the insurance plans and large group pricing on this website is predicated upon joining Elevate Wellness, a national association with over 100,000 members.
Click here to Learn more

Questions? Call 866-201-7191 We're standing by to help you make the best decision.