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Discount Medical Plan Application

Step 1 of 4

Primary Member
Enter Your 9-digit Identification Number including your SSN, Visa, Green Card, etc.
FORM #NB-NB19053

Your membership is effective upon receipt of membership materials.

This is NOT insurance nor is it intended to replace insurance.This discount card program contains a 30 day cancellation period. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR 5.00. This plan provides discounts at certain healthcare providers for medical services. This plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. For a full list of disclosures, please click here. | Limitations, Exclusions and Exceptions | Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475.

Dental Disclosure

* Actual costs and savings vary by provider, service and geographical area.
**As of August 2016.

Dental Benefit is not available to VT residents.

The discount program provides access to the Aetna Dental Access® network, which is administered by Aetna Life Insurance Company (ALIC). ALIC does not offer or administer the discount program, and is not an affiliate, agent or principal of the discount program. Dental providers are independent contractors and not employees or agents of ALIC. ALIC does not provide dental care or treatment and is not responsible for outcomes.

Pharmacy Disclosure

Pharmacy discounts range from 10% to 85% on most medications.

Lab Testing Disclosure

Lab benefit not available in MD, NJ, NY and RI.

Teladoc Disclosure

© 2017 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.  Click here to view a Teladoc Access Map.



Global Travel Assistance Disclosure

Global Travel Assistance

Got a trip planned? Protect yourself and your loved ones. When traveling 100 miles or more from home*, you can rest easy knowing you have a global network of doctors, assistance personnel and emergency benefits. You’ll be safe and sound from air to ground.

  • Emergency medical evacuation
  • Monitoring of treatment
  • Replacement of lost or stolen travel documents
  • Transportation to join a family member in the hospital
  • Return of minor children
  • Pre-travel and security information
  • Coordination of hospital payments and insurance
  • Medications and vaccines
  • Transfer of money
  • Translation services
  • Return of mortal remains

*Home is defined as the address listed on member’s ID (Driver’s License or Passport)