Currently, we have a packet of forms that are used to enroll in our group health insurance plans. In the next few weeks, this will change to online enrollment and greatly simplify the enrollment process.
Since we will be moving the enrollment process online in the next few weeks, we will email the forms to you as needed.
Essentially, the forms consist of the following:
“New Employer Forms” – Within this document are the following documents that must be completed by the Employer:
Client Service Agreement – The employer, person, or entity must complete, sign and return the entire document.
ACH Authorization Form –This form authorizes deductions from your bank account each month for our PEO fee and any other amounts owed to us. Please include a copy of a voided check from this account.
"New Employee Enrollment Forms” – Within this document are the five required forms that must be completed by each employee:
Employment Application – At the bottom of this form is the benefit election section which you will select the type of benefit coverage for you and/or your family.
Immigration (I-9 Form) - You must complete this form by law. You must also provide us with copies of the acceptable documents that establish both identity and employment eligibility. As the worksite employer, you should also keep a copy of these documents.
W-4 Tax Withholding Form - Each individual must complete this form. If you request a specific amount of state withholding, we will send the state withholding form to complete.
ADP Direct Deposit Form – We will directly deposit your pay into your bank account. We will also mail you a copy of your pay stub. Please include a copy of a voided check.
UHC Medical Enrollment Form – Please complete Sections A, B, C & E along with your signature. It is not necessary to include a physician on this form.
Call us at 800-272-0512 Mon - Thurs 9 am to 8 pm EST and until 6 pm on Friday or click here to send us an email