NeuCare Business
Partner Registration

Please complete the form below to enroll your business as NeuCare partner.
Once completed, we will contact you to finalize things and provide a written agreement for you to sign.

Business Info

Name of Business

Owner of Business

First Name

Last Name

Industry or Nature of Business

Number of Employees

Part or Full Time who may be eligible for this benefit.

Business Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Used for all communications, including billing and eligiblity confirmation

Business Phone

(###)

###

####

Sponsorship Details

Please consult with your account and/or HR professional, but generally, details of sponsorship must remain consistent across all employees.

Desired Start Date of Service

YYYY

Eligible persons

Whom will be eligible to join NeuCare under this business account?

Employee only

Employee + spouse

Employee + family

Level of cost sharing

This is the % of membership fee that the BUSINESS will cover for employees who enroll with NeuCare. Typically, this is between 50-100% of membership fees. Employees will be responsible for 100% of any ancillary charges (e.g. medications, labs, procedures, etc.).

Other eligibility requirements

We do encourage the business to keep an updated list of eligible members with us, but will verify each new person added to the account.

Want to become a member of NeuCare? Please complete the enrollment form below to get started.

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NeuCare BusinessPartner Registration

NeuCare Business
Partner Registration