Upay850 2026

1. Click ‘Get Form’ to open the upay850 in the editor.
2. Begin by completing Section 1, ‘Personal Information.’ Fill in your name, employee ID number, home address, work email address, and daytime phone number.
3. If you wish to opt out of coverage, complete Section 2. Check the relevant boxes for the plans you are declining and provide a reason for opting out.
4. In Section 3, indicate your actions by checking all applicable boxes. If enrolling or canceling coverage, follow the instructions to complete Sections 4 through 8 as needed.
5. For medical, dental, and vision plans in Section 4, mark ‘Enroll’ or ‘Cancel’ as appropriate. Ensure you also enter any contributions for Health Savings Accounts in this section.
6. Complete Section 7 if you need to enroll or de-enroll eligible family members. Provide their details and select the appropriate insurance plan boxes.
7. Finally, sign and date Section 8 to confirm that all information is accurate and that you understand the terms of enrollment.

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