Enrollment & Change Form

Complete the Beneplan Enrollment & Change Form when enrolling a new employee, re-enrolling a rehire, or updating an existing employee's information, such as a life event, address change, salary update, or other coverage changes.

Online Form (English)

Beneplan Enrollment And Change Form

Download Printable Version (English)

 Beneplan Enrollment And Change Form

Download Printable Versions (French)

Beneplan Enrollment & Change Form (French)

Online Form (French)

Beneplan Enrollment And Change Form (French)