eProfileTM Registration: Enroll for Online Services

Welcome to our online Registration service.
Welcome to our online Registration service.
Terms and Conditions
By reading this agreement, and clicking the I AGREE button below, you have read, understood, and agree to the following:


USE OF SITE
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You agree that your use of this web site shall be on an "as is" basis. You agree that your use of this web site is entirely at your risk. Neither your Online Provider, nor any of its affiliated or related companies, agents or subcontractors, officers, directors, or employees, nor any other person associated with the creation or maintenance of this web site or its contents, shall be liable or responsible to any person for any harm, loss or damage that may arise in any connection with their use of this web site, including without limitation any direct, indirect, special, third party, or consequential damages. We will not be responsible for any detrimental reliance that you may place upon this web site or its contents.

This web site does not, and is not intended to, provide you with any financial, insurance, legal, healthcare or medical advice. This web site shall not be used, or relied upon by you, as a substitute for your own independent research or for appropriate advice provided to you by a qualified third party professional advisors.

Not all of your Online Provider's products and services may be available in all geographic regions. Nothing on this web site constitutes an offer to buy or sell your Online Provider's products or services. All your Online Provider's products and services shall be subject to the terms and conditions of any applicable agreements.


USER AUTHENTICATION
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In order for your Online Provider to verify a user requesting access to our web site, the web site may prompt the user for certain access information. If the access information entered is confirmed, access will be given to the user without the actual identity of the user being confirmed. The user agrees that the use of this electronic authentication procedure is equivalent legally to the user's written signature.

If your Online Provider in its sole discretion requires additional information or verification before accepting a transaction or transmission, or before granting access to a user, the user agrees to provide such additional information. Your Online Provider reserves the right to restrict or cancel the access of any user to the web site. It is the user's responsibility to keep all access information confidential and to prevent its unauthorized use or disclosure. Your Online Provider may, at its sole discretion, alter, enhance, or amend the type and nature of the access information required to access the web site. Your Online Provider will not be held responsible for any loss or damages which may be incurred by any person as a result of the unauthorized use of access information.
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Wellness Profile
Drug Dental Health

Please take a minute to complete your personal Wellness Profile. The Wellness Profile is your opportunity to identify and receive educational material, coupons and other information related to specific health topics. All correspondence will be customized for you and will be sent to the eProfileTM Account email address on file. You may update your selections at any time through the eProfile menu options.

I authorize my company’s health claims management firm, healthcare professionals and other service providers to exchange information collected in administering my health benefit plan, for the purpose of effectively implementing and maintaining a wellness initiative.

I understand that as part of this initiative I may receive communications regarding possible treatment alternatives or health related benefits and services that may be of interest to me. I understand that I may also be made aware of promotions, drug product specific programs, financial savings opportunities and health educational events in which I may want to voluntarily participate.

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User Profile
General Info Security Question
minimum 3 characters - maximum 15 characters (characters cannot all be numbers)
This is a mandatory field.
This is a mandatory field.
This is a mandatory field.
Group ID must be 6 digits
Certificate must be 10 characters.
Please specify a valid email address.
This is a mandatory field.
This is a mandatory field.
This is a mandatory field.
This is a mandatory field.
This is a mandatory field.
This is a mandatory field.
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Direct Deposit Information
(5 digits)
(min 3 digits, max 4 digits)
(min 1 digit, max 12 digits)
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Alerts
Contact Information Mandatory Alerts Optional Alerts
Your information is invalid. Please try again.
Your information is invalid. Please try again.
Language Correspondence
SMS E-mail
SMS E-mail
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Error
Success