Online Enrollment Form
For other plan designs return to the ENROLL NOW page or use the "back" button on your browser.
To be eligible, all persons listed on the enrollment form must be permanent residents of the listed address.
There is a one-time enrollment fee of $10 for the Plan.
Please complete the enrollment form TODAY so that we may process your request immediately. Plan benefits will begin on the 1st day of the month following receipt of your enrollment. If today is the 1st of the month, your benefits will start TODAY.
If you have any type of medical emergency, DO NOT delay treatment. Such a delay could result serious harm or illness, and might result in expenses that exceed any savings realized by waiting for the plan to go into effect.
Once you have completed the enrollment form, we will send you an email message as your confirmation of receipt. The confirmation will contain instructions and telephone numbers that will allow you to make a claim if you need to before your membership packet arrives (usually in 1-2 weeks).
WBA uses a true Secure Enrollment system powered by Plug'N'Pay Technologies to assure the confidentiality of your personal information.
Member Information Guide and Membership Identification Card(s) will be supplied via U.S. Postal service. Your request authorizes Comprehensive Insurance Agency, LLC, on the behalf of WBA, to charge your credit card or debit your checking account for the initial and subsequent payments to start and continue your WBA membership. Comprehensive Insurance Agency, LLC will charge your credit card or debit your checking account as each modal dues payment comes due. You must provide Comprehensive Insurance Agency, LLC 30 days written notice if you wish to cancel your WBA membership.
After the initial guarantee period has passed, refunds will be based on the following 1st day of the month 30 days AFTER your written request to cancel your membership. Cancellation requests must be in writing or via email. The member will be refunded the unused portion, if any, of dues paid in advance.