Please Identify Yourself

All fields are required.

MyCooper activation code

Enter your activation code as it appears on your enrollment letter or After Visit Summary®. Your code is not case sensitive.

xxxxx
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xxxxx
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xxxxx
Date of birth

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

mm
/
dd
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yyyy

Please enter your ZIP code.

xxxxx

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

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