The Nova Max Instant Savings Card

Advantages of the Nova Max Instant Savings Card:

Insurance Plan	Retail Pharmacy	Mail Order
Managed Care Plan United Healthcare Cigna/Aetna/ Blue Cross Blue Shield	$15 co-pay with Nova Max Instant Savings Card*	Equal to the lowest out of pocket co-pay
Medicare	Covered	Equal to the lowest out of pocket co-pay
Medicaid	Varies by State	Varies by State
No Insurance	$20 cash pay per box with Nova Max Instant Savings Card	Not Available

Title:
First Name: *
Last Name: *
Email Address: *
Address: *

City:* State:* Zip:*

Phone:

What type of Diabetes do you have? *

Which of the following methods do you use to manage your diabetes? *

How often do you test your blood glucose levels? *

What Type of Insurance or reimbursement do you have for your test strips? *