The Quit For Life program is offered to State Health Plan primary members, covered spouses and covered dependent children age 13 or older at no cost as part of your State Health Plan benefits.

Program Enrollment



Enter your information in the fields below and click the NEXT button to continue. All fields are required.


First Name:      
Last Name:      
Middle Initial:    
  (Optional)
Date of Birth (MM/DD/YYYY):        
  (Must be 13 or older to enroll) 


Address 1:    
Address 2:    
City:    
State:
Zip Code:      



Gender:     
Language: 
What is your relationship to the member?