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Please Identify Yourself

Step 1 of 3 All fields are required.

My Bellin Health Access Code

Enter your Access Code as it appears on your enrollment letter (your code is not case sensitive). You will not need to use this code after you complete the signup process.


Please enter the last 4 digits of your Social Security Number.

Date of Birth

Enter your date of birth in the format shown, using 4 digits for the year.

No Activation Code?
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