Healthy Savings - Online Discount Program Application

/ /

Legal Dependents

Add Legal Dependent
First Name MI Last Name DOB Relationship

Membership Fee

Application Fee

$0.00 One-time fee for processing application, printing cards and mailing membership kit.

Cardholder Information



I authorize CareNow to initiate recurring credit card charges as indicated above. My payment will reoccur every 30 days from the date of purchase. Quarterly, semi-annual, and annual enrollments will be charged and debited accordingly, not monthly.

I may cancel at any time, but my cancellation must be received at least 7 business days prior to my next scheduled payment date. I may cancel within the first 30 days for a full refund, less the $5 application fee. However, if I purchased my card during a CareNow visit or just prior to visiting a CareNow center and I give notice of cancellation within the first 30 days, my refund will be less the discount given at the time of service. This situation may require me to pay back a portion of the discount I obtained at the time of service.

I am aware the CareNow Healthy Savings Card is not insurance, and does not meet the Minimum Essential Coverage requirement of the Affordable Care Act. It is a discount card usable for CareNow medical, other doctors, specialists and hospitals, dental, pharmacy, hearing and vision services. I am also aware that when using the CareNow Healthy Savings Card, discounted payment in full is expected at the time of service at all participating medical providers. Card use is limited to the Member, Member’s spouse, and all legal dependents of Member.

I am aware the CareNow Healthy Savings Card cannot be used if I have insurance.

I am aware that advertised discounts for the CareNow Healthy Savings Card are relative to private pay rates, not to third party (insurance) reimbursement rates. Discounts relative to amounts paid under insurance plans will vary according to my plan.

By clicking on the Purchase Healthy Savings Card button I acknowledge that I have read the paragraphs above and that I will abide by the terms and conditions.