Employee Enrollment

Join the plan, or add a dependent to your existing coverage.

Employee enrollment form

Enrollment is handled through a secure form. It takes a few minutes, and you can save and return to it.

Have this ready

Your employer's group name
Date of birth and Social Security number for everyone being enrolled
Your home address and a contact telephone number

When to enroll

Enroll during your employer’s open enrollment period, when you are newly eligible, or within the window following a qualifying life event such as marriage, birth or loss of other coverage. Your employer can confirm the dates that apply to your group.

Read the full policy letter (PDF)

Questions? Reach us at member.services@exemplarhba.com or 1-855-826-3422.