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Complete the enrollment form below.

 Employee ID

Enter your Employee ID with a leading zero (0) to make five digits.

If your EID is already at least 5 digits, you do not need to add preceding zeros.

Your Personal Identification Number (PIN)
Last 4 digits of your Employee ID + Full birth year

Last 4 digits of Employee ID 12345678 or 00029
Full Birth Year 1965
PIN 56781965 or 00291965

We're Here to Help

Licensed long term care specialists are available to assist you in understanding the plan and rates.

Call (877) 286-2852

  Guarantee Issue Until "MM/DD/YYY"
  No Other Benefit Covers LTC
  Issue Age Rates that won't increase as you age