MYGLOBAL™ MEMBER PORTAL REGISTRATION FORM

What is MyGlobal™?

MyGlobal™ offers patients access to their personalized health insurance information over a secure Internet connection.

Who Can Enroll?

To use the MyGlobal™ Member Portal you must:

• Be over 18 years of age
• Have Internet access
• Have a compatible web browser (see disclaimer below for requirements)
• Have a participating primary care provider

How Do I Register?

To begin, read the MyGlobal™ Terms and Conditions statement. Next, you may either fill out and submit the form online, or print out this page, fill in, and mail/fax. You must also check the box confirming that you have read, understood, and agreed to the items detailed in the Terms and Conditions. Once you have completed registration, feel free to contact Customer Care for your unique activation code.

What If I Need Help or Have a Problem with Registering?

Members of our Customer Care team are available to assist you. Please feel free to contact us if you would like help completing the registration form, have any questions about this program, or would like the consent form mailed to your home address.

MyGlobal™ Registration Form

What Happens Next?

You may submit this form by clicking "Submit," or you may print, sign, and send the form to:

GlobalHealth, Inc.
Attn: Customer Care
PO Box 2328
Oklahoma City, OK 73101-2328

Once we receive your signed consent form, we will send access instructions and a personalized secure access code to your home address via US mail.

Browser, System and Connection Requirements:
You must use one of the following Internet browsers to access MyGlobal™:

• Internet Explorer 6.0, 7.0, 8.0 or 9.0
• Mozilla Firefox 2.0, 3.0 or 3.5
• Session Cookies must also be enabled.