Archdiocese of Galveston-Houston Benefit Enrollment Form for: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out your Employee Information. Indicate your status as a Lay Employee, Sister, or Brother, and provide your last name, first name, middle initial, address, social security number, date of birth, and contact information.
Select the Qualifying Life Event (QLE) that applies to you from the provided options such as Marriage or Newborn/Adoption.
Complete the Family Information section by listing dependents. Include their names, social security numbers, genders, relationships to you, and dates of birth. Ensure to check the boxes for medical, dental, vision, and supplemental life coverage as applicable.
Review the Benefits Plans section carefully. Choose your desired plans and note any premiums associated with each option.
In the Authorization section, read through the terms before signing and dating the form to confirm your understanding and agreement.

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