Enrollment Form Basic Information Previous Next Personal Details Select SexMaleFemaleOther Previous Next Address Information Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Previous Next Billing Address Same as Address Above Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Previous Next Dependents Information How many dependents would you like to add?0123456 Dependent 1 Select SexMaleFemale Dependent TypeSpouseChild Dependent 2 Select SexMaleFemale Dependent TypeSpouseChild Dependent 3 Select SexMaleFemale Dependent TypeSpouseChild Dependent 4 Select SexMaleFemale Dependent TypeSpouseChild Dependent 5 Select SexMaleFemale Dependent TypeSpouseChild Dependent 6 Select SexMaleFemale Dependent TypeSpouseChild Previous Next Plan Selection & Effective Date Select Plan TypeHMOPPODiscount Add Vision Coverage Add Teladoc Previous Next Payment Information Select Payment TypeCredit CardAccount Number Select Card TypeVisaMasterCardAmerican ExpressDiscoverExpiration Month010203040506070809101112 Expiration Year2024202520262027202820292030 Previous Next Review & Confirm I have read and agree to the Terms and Conditions I understand my plan will automatically renew until cancelled Customer confirmed all Plan and Payment Information is correct. Customer agreed to the Terms and Conditions. (Customer was given a link to Terms and Conditions. Customer understands that they are committing to this Group Membership Plan for the initial 6 months. By Clicking Submit I authorize my bank to debit my account as identified above to the terms stated here. This authorization shall remain in effect until the Service Provider and bank receive written notification from me of intent to terminate at such time and in such manner as to afford the Service Provider and bank reasonable opportunity to act (Minimum 30 days). I understand that if the total amount owed to the Service Provider is increased, I authorize this plan to continue as long as the payment amount remains unchanged until the amount owed the Service Provider is paid off, or unless the plan is terminated earlier by me as above. I understand any added amounts can be applied for with a new ACH Debit Authorization Form. All other changes such as payment amount, frequency, bank account number change, will require a new ACH Debit Payment Authorization Form to be filled out and submitted to Merchant 15 days prior to any change being implemented. I understand that this payment plan may be cancelled by the Service Provider or Merchant due to NSF (Non- sufficient Funds). I will be liable to pay an NSF fee of $25.00 (or the amount allowable by law), which may be automatically debited for each NSF. I represent and warrant that I am authorized to execute this payment authorization for the purpose of implementing this payment plan. I indemnify and hold the Service Provider, the bank, and Merchant harmless from damage, loss or claim resulting from all authorized actions hereunder. National Association of Better Living (NAOBL) collects visitors' voluntarily-provided personal data through the "Contact" page of this website. This includes all of the displayed information fields. (Visitor name, postal address, E-mail address, telephone number, etc.) Personal information is transmitted using our SSL secure server with 2048-bit encryption for added protection. NAOBL is not responsible for technical problems that are not in direct connection with our server or contacting process that may occur resulting in others viewing your information. The collected information may be used to contact you via phone calls, texts (landline and cell), fax, e-mail, or regular mail to provide you with information that we believe may be of interest to you. Collected information will never be sold or transferred to other parties outside of NAOBL without your permission. All non-personal information (questions, comments, ideas, suggestions and other feedback) is regarded as non-confidential. By sending a message to NAOBL, visitors acknowledge and understand that all non-personal information is considered non-confidential. NAOBL is free to disseminate by any means and use for any purpose this non-confidential information without restrictions and without any obligation to the visitor. By signing the agreement, you are committing to a 12-month commitment for your dental plan enrollment. You will agree to pay the monthly premium of $19.95 a month for 12 consecutive months for the CareTeladocTrio - Single. You can cancel at any time, but will not receive a refund of any paid premium. Failure to fulfill your agreement can allow NAOBL to use all mean necessary to collect any outstanding balance owed including collections efforts via a 3rd party. You will receive all materials for your plan within 10-14 days of your effective date including dental cards and how to use your new plan. After the 12 months your plan will continue, and we will continue to bill you at $19.95 a month until you call to cancel. Please call us at 1-855-970-4179 if you do not receive materials so we can overnight them to you. “By pressing the Send Message button, I expressly consent to be contacted at the phone number I provided (including by phone call, texts (landline and cell), or fax), regarding my message as well as information that NAOBL and We Need Dental, Inc. believes might be of interest to me, using an automatic telephone dialing system and/or artificial or pre-recorded voice, regardless of my status on any state or federal do not call list. I understand that I am not required to provide this consent to make a purchase from NAOBL and We Need Dental, Inc. or to use any of its services, including any online services. Please see our full privacy policy for more information. If a visitor does not wish to be contacted by NAOBL or have questions regarding the website and/or NAOBL's privacy policy, contact us at (855) 970-4179. Terms and Conditions: 1. When canceling your policy with us you must speak to a live agent, we cannot modify your account via voicemail or email. Please call 1-855-970-4179 to cancel and speak to a live agent Monday-Friday 8:30 am-5:00 pm Eastern Standard Time. 2. You must provide 30 days notice of cancellation. If you call in August to cancel your policy will be canceled effective September. You cannot cancel in the month you call. No premium that has already been paid will be refundable after the plan is effective. 3. If you still have any outstanding balance at the time of cancellation it is required that the balance be paid in full at the time of cancellation. Failure to pay any outstanding balance will result in the account potentially being turned over to collections including any charges that the company incurs to collect said debt. 4. If you owe an outstanding balance and your account is canceled, claims will be denied and you will be responsible for the entire office visit or procedure at the dentist's usual and customary fees. 5. If you dispute any monthly fees or dues with your financial institution all claims will be denied and if already paid will be reversed at your provider resulting in you being 100% responsible for all claims. All disputes are subject to civil action including sending to a collection service which may affect your credit negatively. Previous Next Need more info? Reach out and we will assist you more! Send us an email info@naobliving.com Give us a call 866-916-2740