Progress

Please choose your plan.


{{planDetail.message}}

Individual

${{ planDetail.single_price }}/Year

Family

${{ planDetail.family_price }}/Year


*Each plan includes a $10.00 (one-time) processing fee

Enter your personal info

By clicking the "NEXT" button, I expressly authorize Smart Health Dental, LLC, along with their agents and affiliates, to call me or send me recorded messages or texts about their products and services using automated technology to my telephone/cellular number I entered immediately above, which I certify is my own number. I understand that I am not required to consent to be called in order to purchase.

Your dependent info

{{ dependent.dep_relationship }}

{{dependent.dep_first_name}} {{dependent.dep_last_name}}



Enter your billing info

  • card
  • card
  • card
  • card

Please check again and confirm.

If you want to edit please click Previous button

Primary

{{enrollData.first_name}} {{enrollData.last_name}}

{{ dependent.dep_relationship }}

{{dependent.dep_first_name}} {{dependent.dep_last_name}}


{{ enrollData.payment_info.billing_first_name}} {{enrollData.payment_info.billing_last_name }}

{{ enrollData.payment_info.card_number }}

{{ plan_details[enrollData.product_subcode] }}

Yearly premium - ${{ enrollData.payment_amount }}
Enrollment fee - ${{ enrollData.enrollment_fee }}
Total - ${{ ( enrollData.payment_amount - 0 ) + ( enrollData.enrollment_fee - 0 ) }}

Thank you.

We have successfully registered your membership!!
We will send you all details by email. this is your member ID: {{enrollData.confirmInfo.admin123_user_id}}
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