WellPremium™ with Medical Enhanced 10.0

1. Create Customer Account

This page is to enroll members into WellPremium™ with Medical Enhanced 10.0. Please input customer's information below.

Dependent

Dependent

Dependent

Dependent

Dependent

Dependent

Dependent

Dependent

Dependent

Dependent

2. Payment Info

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We have a number of payment options available. We accept Visa, MasterCard or check/from account. Which will you be using today?

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By continuing, you acknowledge that: you are 18 years of age or older; you agree to enroll into WellPremium™ with Medical Enhanced 10.0 ; you desire to accept a gift of limited partnership interest and become a limited partner of Elite Data Group LP in order to be eligible to enroll; you acknowledge that you have read, understand and agree to the New Limited Partner Joinder Agreement and the Gift / Return Agreement; and you hereby authorize the plan administrator, NBFSA, for WellPremium™ with Medical Enhanced 10.0 to deduct $--.-- from your account on a monthly basis. You understand that this authority shall remain in force until you notify WellPremium™ with Medical Enhanced 10.0 or their plan administrator NBFSA of its cancellation; You have given accurate information provided during this enrollment process; and this is not insurance. If you are not satisfied within 30 days after the effective date, you can call 888-424-4186. The Program will then be canceled and any Charges /Fees paid, as shown above, will be refunded.

Summary

  • Benefits

  • WellPREMIUM™ with Medical Enahanced 10.0
  • Select Plan Membership Type & the primary member's date of birth to determine monthly rate.

Total

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