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Telemedicine + Dental Plan

Plan Type: “Individual Plan”

Select a billing option:

Monthly Payment $24.95/Month + $20 Enrollment fee

Yearly Payment $224.95/Year + $20 Enrollment fee
Special: 3 Months Free when Paid Annually

Plan Cost

Enrollment Fee

Discount

Today’s Total Payment:

Contact Information

First Name*

Last Name*

Phone*

Email*

Date of Birth*

Gender*

Billing Address

Street Address*

City*

State*

Zip Code*

Credit Card Information

First Name On Card*

Last Name On Card*

Card Number*

Exp. Month*

Exp. Year*

CVV Code*

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Checkout Summary

Telemedicine + Dental Plan

Plan Type: Individual Payment

Plan Price

Effective Date:

*There is a non-refundable application fee
of $ 20 included with your first payment

Plan Benefits

Dental

Teladoc

Vision

Hearing

Labs

Pharmacy

Checkout

Telemedicine + Dental Plan

Plan Type: “Individual Plan”

Select a billing option:

Plan Cost

Today’s Total Payment:

Contact Information

Billing Address

Credit Card Information

Checkout Summary

Telemedicine + Dental Plan

Plan Type: Individual Payment

Plan Price

$/

Plan Benefits