Get Username/password:

Completing the Username/Password form is essential for accessing your account online. This guide will walk you through each step of the process, ensuring you fill out the necessary information accurately and efficiently.

Follow the steps to successfully complete the form.

1. To obtain the Username/Password form, click the ‘Get Form’ button to access it easily in your preferred format.
2. Begin filling out your personal information in the designated sections. This includes your name, date of birth, address, city, state, zip code, social security number, email address, phone number, and alternate phone number. Ensure that the information is accurate and up-to-date.
3. In the dependents section, list the names of all dependents that will be covered under your benefits. Make sure to include their relationship to you, social security numbers, dates of birth, and addresses as required. If additional space is needed, feel free to add an extra page to the document.
4. Choose your election for medical insurance by checking the appropriate box. Options include waiving coverage or selecting plans such as Employee Only, Employee + Spouse, Employee + Children, or Family.
5. If you wish to utilize flexible spending accounts, make sure to indicate your choices regarding limited purpose and dependent care accounts. Provide the amount you intend to contribute weekly.
6. For any additional insurance options such as dental, vision, short-term disability, and long-term disability, follow the same procedure of indicating your choices by checking the respective boxes.
7. If you are opting for accident insurance or indemnity insurance, specify the level of coverage you desire and list any dependents to be covered, along with their beneficiaries.
8. Finally, review all the information provided to ensure accuracy. After confirming that everything is correct, sign and date the document to acknowledge your selections. Ensure you save any changes made, and proceed to download, print, or share the completed form as needed.

Complete your Username/Password form online today!