Enroll Credit Card

Enrollment into the iHaveNoCoverage Plan by Credit Card is fast and easy, just follow the simple instructions. Make sure to complete all of the fields. When you are done, press submit at the bottom of the page.

Payment Methods
We accept Mastercard, Visa, Discover, American Express, or fill out the enrollment form below. 

You may call us. If you enroll over the phone your coverage will take effect immediately. On-line enrollment may take up to 24 hours to become effective. If you mail your payment your benefits will take effect the same day we receive your check or money order.

Privacy Policy

Contact information including email address, telephone number, address, etc. which is provided by the user is used solely for the purpose of completing the order. Financial information including credit card numbers, expiration dates, billing address is used solely to bill the customer for their order. We do not share or sell any information to any third parties.

Primary Enrollee:
Step 1: Fill out the Contact Information and Select a Benefit Plan.
  First Name
  Last Name
  Date of Birth
  Email Address
  Home Phone:
  Work/Mobile Phone:
  Pick a Plan:
  Agent/Broker you spoke to:

Step 2: Enter the Names and Birth Dates of the Family Members who will covered on the plan. Date of Birth should be filled out like this:
    May 18, 2006 should look like this  
    FirstName LastName Date Of Birth in format MM/DD/YY  

Step 3: Fill out the credit card information that will be used to enroll in the iHaveNoCoverage Plan
    Name on Credit Card:  
    Card Type:  
    Card Number:  
    Expiration Date:   Ex. 05/2006  

By pressing "Submit" I authorize iHaveNoCoverage.com to use the preceding credit card information for enrollment into the iHaveNoCoverage Benefit Program. I understand that I will receive by mail, a credit card authorization notice, notifying me that a credit has been issued on my behalf for this enrollment, including the $25.00 dollar Registration Fee. I will retain this for my record of the transaction.



I HaveNoCoverage.com
355 Plainfield Ave, Suite 6-A
 Edison, NJ 08817
Email: Benefits@ihaveNoCoverage.com
Phone: 1-888-TOOTH-51 (888-866-8451)

Available only in NY and NJ

Because the iHaveNoCoverage.com Discount Benefit Programs are NOT Insurance you can go to a provider as often as you like, with no annual maximum !!!