Download and complete the Health Insurance Enrollment Form for your selected provider. Social Security Number (SSN) and Date of Birth (DOB) are mandatory. Forms must be signed and dated by the subscriber.
Download and complete Affidavit Form (All marital status questions must be answered and form signed and dated by subscriber
Provide a Town or city issued marriage certificate
Download the COBRA Rights Notice (signed by subscriber and spouse)
Download the HIPPA Notice (no signature required)
Download the HSA form if you choose a High Deductible Plan