Enrollment Kits and Forms
Please be sure to make three (3) copies of each application form. One should be retained by the member and the other two are for the HBR.
New Employee Enrollment Kit for BEACON agencies/entities (1.14 MB)
This kit contains all the enrollment materials for new employees of agencies and entities using the BEACON system.
community colleges, and universities using paper enrollment (1 MB)
This kit contains all the enrollment materials for new employees of agencies, public schools, community colleges and universities using paper enrollment.
Enrollment kit for new employees of public schools, agencies
and entities for Benefitfocus (745 KB)
This kit contains all the enrollment materials for new employees of public schools, agencies and entities that enroll electronically through eBenefitsNow.
Enrollment Application
Change Form
Warehouse Requisition
Use this form to order enrollment kits and important forms.
