Instructions
Complete the enrollment & group coverage details eform as soon as you are able to by clicking on "Submit Coverage Details" below.
Note: If you don’t have access to payroll details initially, please submit the additional supporting documentation for premium amounts once available by clicking on "Submit Payroll Details" below.
SpouseSaver Enrollment Forms
Enrollment & Group Coverage Details
Complete general information such as;
Enrollee information
Plan Design
Upload alternate group plan document
Upload Summary of Benefits and Coverage (SBC)
Payroll deduction
Payroll Details
To complete the Spouse Saver enrollment, your spouse is required to;
Provide Premium payment verification from employer
- A paystub showing the premium contribution amount, pre-tax or post-tax and frequency (other information may be blacked out)
