Scott and White

Create my Group User Account

Account ID

Assign Full Administrator Permissions

Contact Information

First Name* Middle Name

Last Name* Name Prefix

Address* Address Line 2

Address Line 3 City*

State* Zip Code*

Phone* Ext.

Account

Account Information

Email Address*

Confirm Email Address

User name must be at least 6 characters long and contain letters, numbers, and/or underscores and no special characters.

User Name*

*Password length must be at least 15 characters and contain an uppercase letter, a lowercase letter, a number and a special character(@#$%^%*()_+|~-=\?{}[]:?;?<>/).

Password

Confirm Password

Show Password

Security Questions

Provide two security questions and answers

Question

Answer

Question

Answer

Privacy Policy

                        Terms of Service

                        1. Accepting the Terms

                        1.1 In order to use the services, you must first agree to the Terms. You may not use the Service
                        if you do not accept the Terms.

                        1.2 You can accept the Terms by

                        (A) clicking to accept or agree to the Terms, where this option is made available to you by
                        FirstCare Health Plans in the user interface for any Service; or

                        (B) by actually using the Services. In this case, you understand and agree that FirstCare Health
                        Plans will treat your use of the Services as acceptance of the Terms from that point onwards.

                        1.3 You may not use the Service and may not accept the Terms if (a) you are not of legal age to form
                        a binding contract with FirstCare Health Plans, or (b) you are a person barred from receiving the Services
                        under the laws of the United States or other countries including the country in which you are a resident or
                        from which you use the Services.

                        1.4 Before you continue, you should print off or save a local copy of the Universal Terms for your
                        records.

I have read the privacy policy

Message

If you would like to include a message to your Group Representative, please enter it here.