MyIMG New User Registration - International Medical Group

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Account Validation

Insured Name

Insured ID

Certificate Number

Account Setup

The email entered is already associated with a MyIMG account.

Please enter a different email or use our Forgot Username or Forgot Password page if you already created an account with this email.

Create Username *

Confirm Username *

Create Password *

Confirm Password *

Email *

Confirm Email *

I have read and agree to IMG's Terms of Use Agreement *

Your agreement is required.

I have read and agree to IMG's Privacy Policy *

Your agreement is required.

Account Access

You have the option to allow others associated with this policy to have visibility to your health and other personal information, including submitting claims on your behalf.

By checking the individual(s) listed below, you authorize this access. If you do not authorize this access, leave the box unchecked and click Finish.

I Authorize ₁

Name ₁

Relationship ₁

Account Access Terms

Re-Disclosure: I understand that when my health information is disclosed pursuant to this Authorization to a party who is not required to comply with the federal or state privacy protection requirements, it may be subject to re-disclosure by the recipient and may no longer be protected.

Revocation: I understand that I have the right to revoke this Authorization at any time, and I may complete such revocation by:

Removing the check mark(s) from the above box(es) next to the name(s) of the party or parties I previously selected; and clicking on the Finish button.

I understand that any revocation will be effective on the date that it is received by IMG. However, my revocation will not be effective to the extent that IMG and/or the other parties that I have authorized to use and disclose my health information have already acted in reliance on this Authorization. Further details of my right to revoke my Authorization may be found in the Privacy of Your Health Information notice.

Voluntary Authorization: I understand that this Authorization is strictly voluntary, and my treatment, payment, enrollment or eligibility for benefits will not be affected if I do not grant access to my family members and/or plan administrator under this Authorization. This authorization will expire on the date you terminate coverage or upon revocation as explained in the terms above.

Copy of Authorization: I have the right to receive a copy of this Authorization, or by submitting an email request to CustomerCare@IMGlobal.com. A photocopy of this Authorization is as valid as the original.

I understand that my health and other personal information is confidential. By clicking on the Finish button below, I implicitly agree to all the statements contained in this Authorization and I acknowledge that I have read, understood and hereby authorize the release of the health and other personal information about me contained on the MyIMG website to the named party or parties selected above.

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