Copower forms 2026

1. Click ‘Get Form’ to open the CoPower ONE Employee Enrollment/Change Form in the editor.
2. Begin by filling out the Employer Information section. Enter the Group Name, CoPower ID#, Contact Person, Contact E-mail, and Contact Phone Number.
3. Next, move to the Member Information section. Fill in your Last Name, First Name, Social Security Number, Street Address, City, State, Zip Code, and Phone Number.
4. Select your CoPower ONE Plan by checking either Good, Better, or Best. If applicable, choose your Dental Plan (PPO or HMO) and provide the Date of Hire and Date of Birth.
5. Indicate the Effective Date for enrollment and complete any additional fields regarding dental office information if enrolling in HMO.
6. In the Dependents section, specify whether you are enrolling or terminating dependents by providing their names and relevant details such as date of birth and relationship.
7. Finally, sign and date the form at the bottom before submitting it via email or fax to ensure timely processing.

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