Thank you choosing the "green solution" to have your Explanation of Benefits Forms (EOBs) delivered electronically. By enrolling in this option, your monthly EOBs will be automatically delivered to the email address entered below.
On this secure page, please complete all information as it appears on your ID card and click "submit"
Data entered should be for the Employee.

Select an Option:
Member First Name:
Member Last Name:
Member ID:
Member Birth Date (M/D/YYYY):
Group Number:
Email Address:
OLD Email Address
(Fill out only if updating your email address):