You can send the business details now. An agent will help you gather employee ages, home ZIPs, eligibility, coverage choices and any dependent details needed.
Use references such as E1 and E2 instead of employee names. Enter ages on the requested effective date; if the date is undecided, use current ages and we will confirm them later. Include employees who expect to waive coverage. Use the coverage choice for medical, or your main benefit if not requesting medical. Note any different dental or vision elections under each employee’s optional details.
Do not enter Social Security numbers, exact birth dates, member IDs, medical conditions, medical records or employee contact details. Keep the reference-to-name list with your business.
One entry per employee: reference, age, home ZIP, status, coverage choice, waiver reason if applicable; then dependent relationship, age and ZIP. Do not include names or sensitive identifiers.