HRA Enrollment Form - O C A Benefit Services 2026

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4.4 out of 5

41 votes

The document is an enrollment form for employee benefits, including health coverage options and direct deposit authorization. It collects personal information from employees, such as name, address, date of birth, and social security number, and allows them to select their desired coverage type. The form also includes a section for dependent information and outlines the use of a mySourceCard™ for qualified expenses. Employees must certify the accuracy of their information and provide signatures for processing.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Company Name at the top of the form. This is essential for proper identification.
Select the type of activity from the options provided: New Hire/Open Enrollment, Re-Hire, or COBRA Elect. Make sure to enter the date coverage begins.
Fill in your Employee Information, including First Name, Last Name, Mailing Address, Date of Birth, Gender, and Social Security Number. Ensure all fields are completed accurately.
In the Elected Coverage(s) section, choose your desired coverage type and indicate if it’s for Employee Only, Employee/Spouse, Parent/Child, or Family.
Sign and date the Employee Enrollment Authorization to certify that all information is correct. This step is crucial for processing your application.
If applicable, complete the Covered Dependent Information section for any dependents you wish to enroll.
Finally, review all entries for accuracy before submitting your form through our platform.

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2014	4.4 Satisfied (41 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are OCA benefits?

The Funds comprehensive medical benefit provides you and your dependents with coverage when you need it most. Below are just some of the benefits included under the medical coverage: Office Visits (including Primary Care, Specialist, Urgent Care and Telehealth) Preventive Screenings and Exams.

How does OCA work?

A one-cancel-all order (OCA) is a bundle of at least three stock or option limit orders placed together. If one of these orders is executed, the remaining orders get canceled. It is an advanced order that is available from broker platforms that cater to experienced traders.

What are the benefits of OCA?

Eating oca Oca is one of the highest vegetable sources of carbohydrate and energy. The tubers are a good source of pro-vitamin A (beta carotene), and also contain potassium, vitamin B6 and small amounts of fibre.

What can I use my OCA benefits card for?

You can use your OCA Debit Card to pay for commuting expenses, or vouchers can be used to pay for transit tickets, passes, or to pay parking vendors.

What is the purpose of the health and dental enrollment form?

This enrollment form allows individuals to apply for group health and dental coverage. Its designed for employees to provide necessary personal information, dependent details, and coverage choices.

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