You're one step away from whole-family care

By providing my payment information and selecting "I Agree," I authorize NROLLNOW to charge my designated credit card, debit card, or bank account for premiums and any authorized recurring payments associated with the benefit plan(s) I have selected.

I understand that recurring payments will continue until canceled according to the terms of my policy or applicable law. I certify that I am the authorized user of the payment method provided.

I consent to receive disclosures, policy documents, notices, and other communications electronically. I understand that electronic signatures carry the same legal effect as handwritten signatures under the Electronic Signatures in Global and National Commerce Act (ESIGN).

Any person who knowingly provides false, incomplete, or misleading information in an application for insurance or for payment of a claim may be guilty of insurance fraud and may be subject to criminal and civil penalties.

Placeholder: state-specific fraud notices required by your state will be inserted here as provided by the issuing carrier.

I acknowledge that I have reviewed the available benefits and voluntarily elect the coverage selected. I understand that premiums, exclusions, waiting periods, limitations, and benefit amounts are described in the policy documents.

Submission of payment or an application does not guarantee approval or issuance of coverage. Coverage becomes effective only after all underwriting, eligibility, and carrier requirements have been satisfied.

I authorize recurring charges according to the selected payment schedule. I understand that future payments may occur automatically until canceled pursuant to the terms of my policy.

Billing frequency: monthly. Amount: $70.00 per month for you and your family. Cancellation: cancel any time by calling (940) 548-3362 or emailing support@ournrollnow.com prior to your next billing date.

End-of-month cancellation policy: if you cancel, your access and billing remain active until the final calendar day of the current month, so there will be no refunds.

Coverage cancels at the end of the month in which you cancel. Your subscription is effective at the first of the month.

Premium payments are subject to the issuing carrier's cancellation and refund policies. Administrative fees, if applicable, may be non-refundable unless otherwise required by law.

By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge and that I am authorized to enroll myself and any listed dependents.

By providing my telephone number, I consent to receive calls and text messages regarding my enrollment, account, and benefits. Message and data rates may apply. Consent is not a condition of purchase.

I authorize NROLLNOW and its payment processor to initiate electronic debit entries to my designated financial institution. I understand that this authorization remains in effect until revoked in writing.

I certify that I am the authorized cardholder and authorize the charges described herein.

I understand that disputes regarding my enrollment or premium payments should first be directed to NROLLNOW at (940) 548-3362 or support@ournrollnow.com before initiating a payment dispute with my financial institution.

By submitting this transaction, I certify that: I am the authorized account holder; the payment information is accurate; I authorize this transaction; I understand the purchase; and I am not using another person's payment credentials without authorization.

Protected health information will be used only as permitted by applicable law and the Privacy Practices of NROLLNOW and the issuing carrier. AdvantEdge is a wellness plan and is not major medical insurance.