Enrollment Agreement

Before You Begin

Be sure to have the following information available to assist in enrolling:

  • Your Taxpayer Identification Number (TIN)   What if I don't have a TIN?
  • Number of employees who will want Employee Only coverage
  • Number of employees who will want Family coverage
  • Company bank account information
  • Your email address
Been Here Before? Sign back in to complete your group's Enrollment Agreement.

If you do not have a TIN, you will be unable to submit an online application. Please call 1-855-211-0742 for assistance.

A new two-person group can submit the following tax documentation:

In lieu of the above tax documents for a new start-up company we can accept both the business license and either the articles of incorporation, articles of organization, or the IRS FEIN letter.