Open Enrollment

As an eligible employee of Wellness Equity Alliance, you are required to complete the form below.

Questions? Email askhr@wellnessequityalliance.com.

COMPLETE ENROLLMENT FORM - ALL ELIGIBLE EMPLOYEES ARE REQUIRED TO COMPLETE THE FORM

Note: For those declining coverage, you are still required to complete Step 7 on the form below.

SAVE YOUR ENROLLMENT FORM

Note: You will upload your enrollment form at the end of Step 3.

Complete the fields below and upload your saved enrollment form.

Note: For eligible employees who are declining coverage, please upload your saved enrollment form as well (Step 7 completed).

Name

First Name

Last Name

Coverage - Select one.

I accept coverage.

I decline coverage.

Open Enrollment Documents

See links below for all documents related to open enrollment for Wellness Equity Alliance.

Questions? Email askhr@wellnessequityalliance.com.