Online Banking
Group or Member Information
*Who Are You?
*Indicates Required Input
Group Number:
Valid group numbers contain no letters Enter your Group Number / ID That's too many numbers  
*Company Name:
Company name is required Enter company name Company name has too many characters 100 max.  
Member Number:
 
*Policy Holder First Name:
Policy holder first name is required Enter policy holder first name  
*Policy Holder Last Name:
Policy holder last name is required Enter policy holder last name  
*Street Address:
Street address is required Enter street address Street address has too many characters (100 max)  
Apt/Suite:
 
*City:
City name is required Enter city name Too many characters in city name (50 max)  
*State:

 (NM residents click here)

 2 letter state abbreviation is required Enter 2 character state abbreviation Enter only 2 character state abbreviation  
*Zip:
Zip code is required Enter 5 digit zip code Enter only 5 digits  
Phone Number:
Enter only 10 numbers Enter 10 numbers Only 10 numbers  
*Email Address:
Email Address is required Enter a valid email address Too many characters in email address (100 max)  
Contact Name:

 (if different than policy holder)

 Enter account contact name if different than name on bank account Too many characters in contact name (100 max)  


Debit Account Information
*Bank Account Holder's Name:
Account holder name is required Enter bank account holder's name Too many characters in account holder name (100 max)  
*Checking or Savings:
Checking  
Savings
*Bank Routing Number:
Use only numbers A 9 digit bank routing number is required Enter 9 digit bank routing number Enter only 9 digits for bank routing number  
*Confirm Routing Number:
Routing numbers must match.  
*Bank Account Number:
Use only numbers A 5 to 17 digit bank account number is required Enter 5 to 17 digits only Too many characters (17 max)  
*Confirm Account Number:
The values don't match.  


Premium Payment Information
Setup your recurring premium payment here and we will deduct the premium each month.
Automatic Monthly Premium Payments:
Yes, I would like automatic monthly recurring premium payments
*Recurring Start Date:
Date format is incorrect Date must be 3 days from today's date You must select a date that is at least 3 days from today.  
  Your recurring amount will be updated if your premium changes. Recurring start dates must be at least 3 days from today's date.  
You can make a one time payment to catch up or control your own payment schedule.
One Time Premium Payment:
Yes, I would like to make a one time premium payment
*One Time Amount:
Required format and minimum is 1.00 (including cents) An amount formatted as 1.00 or more is required (include cents) Minimum amount is 1.00 (include cents) An amount formatted as 1.00 or more is required (include cents)  
*One-time Withdrawal Date
Date format is incorrect Date must be 3 days from today's date You must select a date that is at least 3 days from today.  
  Your one-time payment will be deducted on your withdrawal date. Withdrawal date must be, at least, 3 days from today's date.  

Disclosure Agreement

Please read the following agreement:

I hereby authorize BEST Life and Health Insurance Company to process payments as I specified and submitted on this portal.

By typing my name below and checking the acknowledge box, I am stating I read and understood the terms, I am authorized to do so for the account, and understand if the box is checked for recurring/auto pay it means payments will automatically process monthly on the date stated for amounts due. Any changes or stops to recurring or auto payments must be done by reaching out directly to BEST Life and Health Insurance Customer Service at 877-205-8767 or email cs@bestlife.com.

Enter your full name to proceed Your first and last name is required Enter your first and last name Too many characters (50 max) Check the box if you agree to proceed. *I read the terms and I agree.

 

Terminating Coverage:

Terminating your dental insurance with the Marketplace/Exchange will not terminate your recurring or prepaid payments. If you wish to continue coverage, simply continue your recurring or prepaid payments and your coverage will continue as an Off-Exchange plan. If you wish to terminate your plan, contact BEST Life at 877.205.8767 within 35 days of your exchange termination date to stop your payments and we will terminate your plan as of the original Marketplace/Exchange termination date on record. If you contact us after said 35 days we will terminate as of the day you notify us, or any date you specify after this notification date, provided you are paid up through said date. Any coverage will only be effective through the date of coverage payment. Any coverage days that are not paid current will be terminated. If you elected to sign up for automatic recurring payments, recurring payment members will automatically have paperless billings.