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Annual Membership Rates

Member Only $ 69
Member + 1 $ 99
Member + Family $ 119

Membership fees are payable annually or upon joining or renewing.

There is no application fee for SecureOne Plan.
  Dental ▪ Vision ▪ Telemedicine ▪ Chiropractic ▪ Hearing ▪ Pharmacy

  Thank you for selecting SecureOne Plan. When you join SecureOne Plan, you and your family receive preferred rates and comprehensive dental savings with no limits on use and no waiting. In addition, you receive access to and preferred rates for vision, telemedicine, chiropractic, hearing and pharmacy services.
To join online, complete this form and submit it with your payment. If you are working with an insurance Broker, please enter his or her information as well.
Your membership period will be 12 months from the date your membership is approved. Upon approval, your ID card and plan documents will be mailed to the address submitted.
If you have joined previously and would like to add family members, please add him/her as a Member on a separate plan. The appropriate membership fee will be charged for the additional member(s). When your own dental plan renews, you may add your family members to your coverage at that time.
SecureOne Plan reserves the right to change or discontinue certain discount plan services. Members will be notified of such discontinuance.
An * means that the field is required and has to be filled in with the requested information.
Member Information
*  I would like to
*  Are you adding additional family members?
*  Member ID:
    SSN:   -     -    
*  Title:
*  Last Name:
*  First Name:
*  Address 1:
    Address 2:
*  City:
*  State:
*  Zip Code:
*  Gender:
*  Date of Birth:             (mm/dd/yyyy)
*  Home Phone:   -     -  
*  Work Phone:   -     -  
*  Email Address:
Additional Family Member Information
To add a dependent, complete the required fields and click the "Add" button.
    SSN:   -     -  
*  Relation:
*  Last Name:
*  First Name:
*  Gender:
*  Date of Birth:             (mm/dd/yyyy)
Current Additions:
Annual Membership Rate
Member Only - $69
How did you hear about SecureOne Plan?
*  Select One:

Please enter Name of person or office that referred you to us.
Promotional Code
If you have a promotional code, please enter it here.   
Broker Information
*  Is there a broker that referred you to SecureOne Plan?
*  Broker First Name:
*  Broker Last Name:
*  Agency:
*  Broker Email:
*  Broker Phone:   -     -  
    General Agency Name:
Disclosures THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. This is not a Medicare prescription drug plan. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at www.secureoneplan.com. A written list of participating providers is available upon request.

Discount Medical Plan Organization and administrator: SecureOne Plan, 777 E Missouri Ave, Suite 121, Phoenix, AZ 85014; phone 888-429-0914.

The program and its administrators have no liability for providing or guaranteeing service by providers or the quality of service rendered by providers.

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A Southwest Preferred Dental Plan
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