Member
Application Section
Welcome to the Genesis member application section. We have just
a few instructions
that we want to go over before you print
and fill out your application.
PLEASE BEFORE YOU FILL OUT YOUR APPLICATION CHECK FOR PROVIDERS
IN YOUR AREA TO MAKE SURE THAT THERE ARE A SUFFICIENT AMOUNT OF PROVIDERS.
WE AT GENESIS WANT YOU TO GET THE QUALITY OF HEALTH CARE YOU
DESERVE.
1. Print neatly so when the form makes it to the home office there will be no mistakes.2. Do not forget to place your birthday and social security number on the form, this is very important.
3. Unless an IMR has recommended this program to you disregard the IMR information.
4. Total your first payment: If paying monthly you must send the first payment plus the processing fee ($89 + $35 = $124),
to authorize the monthly bank draft must fill out the payment authorization form along with a voided check to be sent with a this option. You may also pay by credit or debit card using the payment authorization form.
If paying Quarterly send $267 plus $35(you are sent a statement for quarterly if you choose),
if paying Annually send $979 plus $35(you get a free month for paying annually).5. Read the member terms and conditions and then sign and date your form.
Your bank draft dates will be determined as follows:
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You have three choices for payment dates, the 12th, 17th and the 22nd.
All memberships will become effective on the first day of the month following receiving the application in the Genesis Direct office.
If
you have any questions on how to fill out the application, want information on credit card payments or are interested in monthly paper billing call the Genesis Direct billing office at 1-888-202-1722.
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Your draft date will be determined as indicated above.Make sure you place the routing number and bank account number from your voided check in the appropriate place.Fill out all requested dependent information.When you get your information packet and member cards read them thoroughly. Also make use of the toll free customer service numbers provided to confirm that the provider that you choose is still valid in the network. That information will help to maximize the use of your program.We offer different types of memberships at Genesis Direct. They range from $89 per month which includes everything you read in the presentation section down to $29 per month for everything except the PPO doctors and facilities. Again if you are confused on which membership is best for you call Genesis at 1-888-202-1722.Click the link below, print out the form and choose the plan that best fits your needs, fill out the form then sign the member terms, fill out payment authorization and mail completed form back to us with draft information and voided check (if you have one)or credit card information. Also don't forget to send the first payment with application fee.If you have any questions call the number above or email us at genesisdirect@hughes.net.To print off a Genesis application click here.