;
Member Registration
Step 1: Enter Member Details
Step 2: Select a Plan
Step 3: Enroll
Physician Primary Care Plan
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Physician Primary Care Plan
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Step 1: Enter Member Details
Member Details
:
First Name
*
Last Name
*
Date of Birth
*
Age
*
Gender
Male
Female
Salutation
*
Email
*
Mobile Number
*
-
Country
*
State
*
City
*
ZIP / Postal Code
*
-
5-digit ZIP
4-digit ZIP
Login Credentials
:
UserName
*
Confirm Username
*
Password
*
Confirm Password
*
Enable 2-factor authentication
:
Everytime
Only when system change
Do you want to Enroll Plan
I Accept the
for Member
Check Terms and Condition
Step 2: Select a Plan
Search Plans by Facility Name or Provider Name
:
Facility Name
OR
Provider Name
OR
Plan Name
Change search
Back
Search
Select a plan
:
Select
Plan Name
Provider Name
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Select a payment schedule
:
Plan start date
*
Payment Schedule
Total Amount
No. of Installments
Installment Amount
Installment Fee
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Next
Step 3: Enroll
Selected plan
:
Plan Name
Plan Type
Plan Duration
Enrollment Fee
Plan Amount
Plan Start date
Plan End Date
Visit Fee
Installment Amount
Installment Fee
Payment Schedule
Terms (No. of payments)
Plan Decription
AccountID
Pay Now
:
Please enter Card Details :
Amount
*
Card Number
*
Name On Card
*
Expiry Date (MM/YY)
*
CVV
*
I Accept the
Terms & Conditions
for Member
Check Terms and Condition
Next
Clear
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Submit
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