Application: Step 1 

This form is for applicants who have not had an active enrollment within the past 12 months.

• If you have not had an active enrollment within the past 12 months, please click the "Continue" button below.



• If you have had an active enrollment within the past 12 months and would like to re-enroll in the HealthWell program, you will receive a re-enrollment application in the mail about 6 weeks before your enrollment expires. If you do not receive the packet, please contact the HealthWell Foundation at 800-675-8416 or info@healthwellfoundation.org.