Join Step 1 - American Better Health Organization

Step 1 Information

Step 2

Step 3

Complete

Indicates required fields*

Effective Date *

State *

Membership Plan *

Metropolitan Life Insurance Company Certificate Delivery

Electronic

MetLife Disclosures

I have read and understand the contents of The Cancer Insurance Shopper's Guide

Family Status *

Benefit Amount *

Total Monthly Cost

Association Benefits

Insurance Benefits

Complementary Discount Benefits

Email *

Phone *

X

Secondary

X

Address 1 *

Address 2

City *

State

ZIP Code *

(+) Add eligible family member

Health Benefits

Step 1

Step 2 Payment

Step 3

Complete

Primary Payment

Indicates required fields*

Method of Payment *

Name & Address

Same as Member

Name On Card *

Relationship *

Billing Address *

City *

State *

Zip *

Card Number *

CVV *

Expiration Date *

/

Name & Address

Same as Member

Account Type *

Routing Number *

Account Number *

Backup Payment

You can optionally specify a Backup Payment Method. Your Backup Payment Method would only be used if your Primary Payment Method fails.

Method of Payment *

Name & Address

Same as Member

Name On Card *

Relationship *

Billing Address *

City *

State *

Zip *

Card Number *

CVV *

Expiration Date *

/

Name & Address

Same as Member

Account Type *

Routing Number *

Account Number *

Membership Summary

Membership Plan

Family Status

Benefit Amount

Association Benefits

Insurance Benefits

Complimentary Discount Benefits

Effective Date

Pay Mode *

Payment

Enrollment Fee

Step 1

Step 2

Step 3 Agreement

Complete

ABHO Membership Agreement

Privacy Policy, Legal Agreement, and Membership Terms

By checking this box, I accept and agree to the Privacy Policy, and Legal Agreement, including the Dispute Resolution provision and the Membership Terms, including the Automatic Payment & Renewal provision.

Proxy Voting Rights

Enroll into ABHO with Proxy Voting Rights Assigned

MetLife Consumer Privacy Notice, Fraud Warning, and Outlines of Coverage

I have read my enrollment materials and I request coverage for the benefits for which I am or may become eligible. I understand that contributions are required for the benefits of my membership. For Minnesota State residents- If I am enrolling for Critical Illness Insurance: I declare that all individuals to be insured have medical coverage in force that provides benefits for medical treatment, including hospital, surgical, and medical expenses. I have received and read a copy of the Outline of Coverage or other disclosure document for the Critical Illness Insurance. In certain states, Critical Illness coverage may be referred to as Critical Illness Insurance, Specified Disease Insurance, Limited Benefit Insurance, or Limited Benefit Critical Illness Insurance.

The following disclosure is required by New Mexico law: This type of plan is NOT considered "minimum essential coverage" under the Affordable Care Act and therefore does NOT satisfy the individual mandate that you have health insurance coverage. If you do not have other health insurance coverage, you may be subject to a federal tax penalty.

By checking this box, I attest I have read and understand the following: MetLife Consumer Privacy Notice, Fraud Warning, Critical Illness Outline of Coverage, Critical Illness Disclaimer, A Shopper's Guide to Cancer Insurance, Hospital Indemnity Outline of Coverage, Medicare Disclosure.

Attestation & Agreement

Step 1

Step 2

Step 3

Complete

Thank you!

Status

Member Name

Member ID

Pay Mode

Payment

Enrollment Fee

Membership Plan

Effective Date

Family Status

Benefit Amount

Association Benefits

Insurance Benefits

Complimentary Discount Benefits

Disclosures

MetLife Consumer Privacy Notice, Fraud Warning, Critical Illness Outline of Coverage, Critical Illness Disclaimer, A Shopper's Guide to Cancer Insurance, Hospital Indemnity Outline of Coverage, Medicare Disclosure

Helping Americans

Live Healthier, Happier Lives

JOIN ABHO

Membership Enrollment

Primary Payment

Backup Payment

Membership Summary

ABHO Membership Agreement

Thank you!

Features of ABHO

Benefits of ABHO