My Health Toolkit - Request Access Code

Request Access Code

Request Confirmation

Acknowledgement of Receipt

Frequently asked questions
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Request Access Code

Only authorized employers will receive an access code. If you need authorization, please contact your marketing representative for details before requesting access.

If you are a member who wants claims and benefits information, you'll find it in Member My Health Toolkit.
If you are a provider who wants your patient's claims and benefits information, you'll find it in Provider My Health Toolkit.

Requesting an access code is easy! Please complete this form and we will send you an access code.

General Information

Group Group Number: (refer to the group bill for this number) Group Name:

Security Last 6 Digits of Your Social Security Number: Date of Birth: (mm/dd/yyyy)

Name First Name: Middle Initial: Last Name: Suffix :

Address Address Line 1: Address Line 2: City: State/Province: ZIP Code: Country:

Contact Daytime Phone Number: (555-555-5555) (Extension) Fax Number: (555-555-5555)

or Cancel

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Why do I have to request an access code? Why can’t I just create a profile?

When/how will I receive my access code?

What is the group number and where do I get it?

Request Access Code

General Information