Your Personal Information
 
[*] indicates a required field
*Member Number:
*Date of Birth:
*First Name:
M.I.:
*Last Name:
*Gender:
I am a resident of Arizona.
Zip Code:
*Social Security Number:
*Group Number:
Employee Number:  
*Email Address:
*Confirm E-mail Address:
 
 
Delivery Preferences
Explanation of Benefits:
  • Paperless delivery, including e-mail notification of BlueNet availability
  • U.S. mail delivery
Benefit Books and Benefit Riders: More Information;
  • Paperless delivery, including e-mail notification of BlueNet availability
  • U.S. mail delivery
 
Login ID Information
Please choose a login ID & password for your account.
 
*Establish Unique Login ID:
*User Password:
*Confirm Password:
Your password must meet the following criteria.
    1. Password must be a minimum of 8 characters in length.
    2. Password must include one letter [a-z or A-Z] one number [0-9].
    3. Password cannot include spaces or special characters (&, %, *, etc.)
    4. Password is case sensitive.

 
Alternate Security Question
We require an additional security question to reference, in case you forget your password.
 
Question to be asked if you forget your password:
* If you selected OTHER please provide your question:
Please provide the answer to your question:
Terms and Conditions
I have read and I agree to the Online Services Terms of Use as outlined above.
 
 
Electronic Benefit Books and Benefit Riders
  • We will notify you by U.S. Mail when your benefit book is available and by e-mail when your EOBs are available.

  • You are responsible for notifying us if you change your physical or e-mail address.

  • If our attempt to provide notification via e-mail fails, we will notify you by letter and switch your delivery preference back to U.S. mail.
 

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