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Secure Order Form
To order by credit card, select either the monthly or annual discount plan choice below and then click the "Add To Cart" button beneath your choice. This plan is not insurance.
To send a check for annual payment or have the monthly amount deducted from your checking account, print and mail the paper application form at bottom of page.
Disclosure: The OptumHealthSM Allies discount plan is administered by HealthAllies®, Inc., a discount medical discount plan organization. The OptumHealthSM Allies discount plan is NOT insurance. The OptumHealthSM Allies discount plan provides discounts at certain health care providers for medical services. The OptumHealthSM Allies discount plan does not make payments directly to the providers of medical services. The discount plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. HealthAllies, Inc., is located at P.O. Box 10340, Glendale, CA, 91209, 800-377-0263, www.pihc.optumhealthallies.com, OHACustomerCare@OptumHealth.com . For members living in Massachusetts: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. The range of discounts for specified medical, pharmacy or ancillary services provided under the plan will vary depending upon the type of provider and the type of services received.
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If you cancel within 30 days of the effective date (within 30 days of receipt of membership materials for residents of CO, IN, MO, MT, ND, OH, OK, SC, SD and WA), you will receive a full refund. (The application fee, if required, is not refundable except in AR, CO, MD, and TN.) The program and its administrators have no liability for providing or guaranteeing service or the quality of service rendered.
