Employee enrollment application 2026

1. Click ‘Get Form’ to open the employee enrollment application in the editor.
2. Begin by filling out the Subscriber Information section. Enter your last name, first name, middle initial, and Social Security number. Ensure all fields are completed to avoid processing delays.
3. Indicate the reason for your application by selecting one of the options provided, such as 'New group enrollment' or 'Open enrollment'. Be sure to include relevant dates where applicable.
4. In Section 1a, select your preferred health plan from the options listed. Review each plan carefully before making your selection.
5. If applicable, complete Section 1b for Specialty Benefits by referring to the attached Specialty Benefits Employee Benefit Selection Form.
6. Continue through each section, providing necessary information about dental and vision coverage selections as well as dependent information if enrolling family members.
7. Finally, review all entered information for accuracy and sign the acknowledgment at the end of the form before submitting it through our platform.

Start using our platform today to easily fill out your employee enrollment application for free!