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Your Full Name*
First Last
Email Address*
Phone Number
Address*
City State
What kind of membership are you seeking?*
What is the age of the primary member? (Person applying)*
Do you currently pay, on a monthly basis for medical coverage?*
How much per month do you currently pay for your coverage?*
(No need for $ sign, just use numbers – example: 1000)
What is your current deductible?
(No need for $ sign, just use numbers – example: 1000)
Do you or anyone in the household applying use tobacco?*
Do you live in the US?*
Currently not accepting new members in Alaska, Washington, New York, Illinois, and Vermont. Please contact us with any questions.
Untitled*
- I agree to receive information about pricing and related membership details via email from Scoop Health.
We will not share your contact information with anyone. By submitting your email and phone number, you agree to be contacted by Scoop Health and its Affiliates. You may opt-out any time.
Member Only - 18 - 500IUA
Member Only - 18 - 500IUA - Smoking
Member Only - 18 - 1000IUA
Member Only - 18 - 1000IUA - Smoking
Member Only - 18 - 1500IUA
Member Only - 18 - 1500IUA - Smoking
Member Only - 18 - 2500IUA
Member Only - 18 - 2500IUA - Smoking
Member Only - 18 - 5000IUA
Member Only - 18 - 5000IUA - Smoking
Member Only - 30 - 500IUA
Member Only - 30 - 500IUA - Smoking
Member Only - 30 - 1000IUA
Member Only - 30 - 1000IUA - Smoking
Member Only - 30 - 1500IUA
Member Only - 30 - 1500IUA - Smoking
Member Only - 30 - 2500IUA
Member Only - 30 - 2500IUA - Smoking
Member Only - 30 - 5000IUA
Member Only - 30 - 5000IUA - Smoking
Member Only - 40 - 500IUA
Member Only - 40 - 500IUA - Smoking
Member Only - 40 - 1000IUA
Member Only - 40 - 1000IUA - Smoking
Member Only - 40 - 1500IUA
Member Only - 40 - 1500IUA - Smoking
Member Only - 40 - 2500IUA
Member Only - 40 - 2500IUA - Smoking
Member Only - 40 - 5000IUA
Member Only - 40 - 5000IUA - Smoking
Member Only - 50 - 500IUA
Member Only - 50 - 500IUA - Smoking
Member Only - 50 - 1000IUA
Member Only - 50 - 1000IUA - Smoking
Member Only - 50 - 1500IUA
Member Only - 50 - 1500IUA - Smoking
Member Only - 50 - 2500IUA
Member Only - 50 - 2500IUA - Smoking
Member Only - 50 - 5000IUA
Member Only - 50 - 5000IUA - Smoking
Member Only - 60 - 500IUA
Member Only - 60 - 500IUA - Smoking
Member Only - 60 - 1000IUA
Member Only - 60 - 1000IUA - Smoking
Member Only - 60 - 1500IUA
Member Only - 60 - 1500IUA - Smoking
Member Only - 60 - 2500IUA
Member Only - 60 - 2500IUA - Smoking
Member Only - 60 - 5000IUA
Member Only - 60 - 5000IUA - Smoking
Member + Spouse - 18 - 500IUA
Member + Spouse - 18 - 500IUA - Smoking
Member + Spouse - 18 - 1000IUA
Member + Spouse - 18 - 1000IUA - Smoking
Member + Spouse - 18 - 1500IUA
Member + Spouse - 18 - 1500IUA - Smoking
Member + Spouse - 18 - 2500IUA
Member + Spouse - 18 - 2500IUA - Smoking
Member + Spouse - 18 - 5000IUA
Member + Spouse - 18 - 5000IUA - Smoking
Member + Spouse - 30 - 500IUA
Member + Spouse - 30 - 500IUA - Smoking
Member + Spouse - 30 - 1000IUA
Member + Spouse - 30 - 1000IUA - Smoking
Member + Spouse - 30 - 1500IUA
Member + Spouse - 30 - 1500IUA - Smoking
Member + Spouse - 30 - 2500IUA
Member + Spouse - 30 - 2500IUA - Smoking
Member + Spouse - 30 - 5000IUA
Member + Spouse - 30 - 5000IUA - Smoking
Member + Spouse - 40 - 500IUA
Member + Spouse - 40 - 500IUA - Smoking
Member + Spouse - 40 - 1000IUA
Member + Spouse - 40 - 1000IUA - Smoking
Member + Spouse - 40 - 1500IUA
Member + Spouse - 40 - 1500IUA - Smoking
Member + Spouse - 40 - 2500IUA
Member + Spouse - 40 - 2500IUA - Smoking
Member + Spouse - 40 - 5000IUA
Member + Spouse - 40 - 5000IUA - Smoking
Member + Spouse - 50 - 500IUA
Member + Spouse - 50 - 500IUA - Smoking
Member + Spouse - 50 - 1000IUA
Member + Spouse - 50 - 1000IUA - Smoking
Member + Spouse - 50 - 1500IUA
Member + Spouse - 50 - 1500IUA - Smoking
Member + Spouse - 50 - 2500IUA
Member + Spouse - 50 - 2500IUA - Smoking
Member + Spouse - 50 - 5000IUA
Member + Spouse - 50 - 5000IUA - Smoking
Member + Spouse - 60 - 500IUA
Member + Spouse - 60 - 500IUA - Smoking
Member + Spouse - 60 - 1000IUA
Member + Spouse - 60 - 1000IUA - Smoking
Member + Spouse - 60 - 1500IUA
Member + Spouse - 60 - 1500IUA - Smoking
Member + Spouse - 60 - 2500IUA
Member + Spouse - 60 - 2500IUA - Smoking
Member + Spouse - 60 - 5000IUA
Member + Spouse - 60 - 5000IUA - Smoking
Member + Child - 18 - 500IUA
Member + Child - 18 - 500IUA - Smoking
Member + Child - 18 - 1000IUA
Member + Child - 18 - 1000IUA - Smoking
Member + Child - 18 - 1500IUA
Member + Child - 18 - 1500IUA - Smoking
Member + Child - 18 - 2500IUA
Member + Child - 18 - 2500IUA - Smoking
Member + Child - 18 - 5000IUA
Member + Child - 18 - 5000IUA - Smoking
Member + Child - 30 - 500IUA
Member + Child - 30 - 500IUA - Smoking
Member + Child - 30 - 1000IUA
Member + Child - 30 - 1000IUA - Smoking
Member + Child - 30 - 1500IUA
Member + Child - 30 - 1500IUA - Smoking
Member + Child - 30 - 2500IUA
Member + Child - 30 - 2500IUA - Smoking
Member + Child - 30 - 5000IUA
Member + Child - 30 - 5000IUA - Smoking
Member + Child - 40 - 500IUA
Member + Child - 40 - 500IUA - Smoking
Member + Child - 40 - 1000IUA
Member + Child - 40 - 1000IUA - Smoking
Member + Child - 40 - 1500IUA
Member + Child - 40 - 1500IUA - Smoking
Member + Child - 40 - 2500IUA
Member + Child - 40 - 2500IUA - Smoking
Member + Child - 40 - 5000IUA
Member + Child - 40 - 5000IUA - Smoking
Member + Child - 50 - 500IUA
Member + Child - 50 - 500IUA - Smoking
Member + Child - 50 - 1000IUA
Member + Child - 50 - 1000IUA - Smoking
Member + Child - 50 - 1500IUA
Member + Child - 50 - 1500IUA - Smoking
Member + Child - 50 - 2500IUA
Member + Child - 50 - 2500IUA - Smoking
Member + Child - 50 - 5000IUA
Member + Child - 50 - 5000IUA - Smoking
Member + Child - 60 - 500IUA
Member + Child - 60 - 500IUA - Smoking
Member + Child - 60 - 1000IUA
Member + Child - 60 - 1000IUA - Smoking
Member + Child - 60 - 1500IUA
Member + Child - 60 - 1500IUA - Smoking
Member + Child - 60 - 2500IUA
Member + Child - 60 - 2500IUA - Smoking
Member + Child - 60 - 5000IUA
Member + Child - 60 - 5000IUA - Smoking
Member + Family - 18 - 500IUA
Member + Family - 18 - 500IUA - Smoking
Member + Family - 18 - 1000IUA
Member + Family - 18 - 1000IUA - Smoking
Member + Family - 18 - 1500IUA
Member + Family - 18 - 1500IUA - Smoking
Member + Family - 18 - 2500IUA
Member + Family - 18 - 2500IUA - Smoking
Member + Family - 18 - 5000IUA
Member + Family - 18 - 5000IUA - Smoking
Member + Family - 30 - 500IUA
Member + Family - 30 - 500IUA - Smoking
Member + Family - 30 - 1000IUA
Member + Family - 30 - 1000IUA - Smoking
Member + Family - 30 - 1500IUA
Member + Family - 30 - 1500IUA - Smoking
Member + Family - 30 - 2500IUA
Member + Family - 30 - 2500IUA - Smoking
Member + Family - 30 - 5000IUA
Member + Family - 30 - 5000IUA - Smoking
Member + Family - 40 - 500IUA
Member + Family - 40 - 500IUA - Smoking
Member + Family - 40 - 1000IUA
Member + Family - 40 - 1000IUA - Smoking
Member + Family - 40 - 1500IUA
Member + Family - 40 - 1500IUA - Smoking
Member + Family - 40 - 2500IUA
Member + Family - 40 - 2500IUA - Smoking
Member + Family - 40 - 5000IUA
Member + Family - 40 - 5000IUA - Smoking
Member + Family - 50 - 500IUA
Member + Family - 50 - 500IUA - Smoking
Member + Family - 50 - 1000IUA
Member + Family - 50 - 1000IUA - Smoking
Member + Family - 50 - 1500IUA
Member + Family - 50 - 1500IUA - Smoking
Member + Family - 50 - 2500IUA
Member + Family - 50 - 2500IUA - Smoking
Member + Family - 50 - 5000IUA
Member + Family - 50 - 5000IUA - Smoking
Member + Family - 60 - 500IUA
Member + Family - 60 - 500IUA - Smoking
Member + Family - 60 - 1000IUA
Member + Family - 60 - 1000IUA - Smoking
Member + Family - 60 - 1500IUA
Member + Family - 60 - 1500IUA - Smoking
Member + Family - 60 - 2500IUA
Member + Family - 60 - 2500IUA - Smoking
Member + Family - 60 - 5000IUA
Member + Family - 60 - 5000IUA - Smoking
NA

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