Download Eligibility File or Fill out the Forms.

There are two types of Enrollments Employers and Individuals. The first way is to download the enrollment form and upload it into the company portal. This will allow you to add all the information into an excel file and upload it. This is the easiest way to add multiple members to the plan when there are many. The second way is to fill out each form here on the site. Human Resources may wish to upload the an excel file themselves or send employees here to fill out the forms for themselves. Filling out the forms is sometimes easier than trying to share an excel file. Before you start, make sure you understand the types of members by reading the Explanation of My Health Membership Types section below.

Explanation of my health membership Member types

Employee or Primary Member

Employee Spouse / Domestic Partner

An Employee or Primary member is the main person on the membership. This person is either the main contact and responsible for payment or is the employee who's membership is being paid for or subsidized through their employment.

Employee Spouse / Domestic Partner

A Spouse or Domestic Partner is someone who is in the same household. A Spouse or Domestic Partner is listed under the Primary Member. Every Spouse or Domestic Partner must have a Primary member and be on the same Plan Type.

Dependents

Dependents are Adult Children ages 18-25 that are still being cared for by the Primary Member. Dependents are typically college students or young adults still being claimed as a dependent by the primary member. Every Dependent must have a Primary member and be on the same Plan Type.

Children

Dependents

Children are under the age of 18 and are the responsibility of the Primary member. Every child must be associated with a Primary member and be on the same Plan Type.

Fill out The First Form for Individuals

Spouse or Domestic Partner Form

Fill out The First Form for Spouses or Single Dependents

Dependent 1 Eligibility Form (18-25 year-olds)

Fill out The First Form for Dependent #1

Dependent 2 Eligibility Form (18-25 year-olds)

Fill out The First Form for Dependents

Child 1 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #1

Child 2 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #2

Child 3 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #3

Child 4 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #4

Child 5 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #5

Download Eligibility File or Fill out the Forms.

Explanation of my health membership Member types

Employee or Primary Member

Employee Spouse / Domestic Partner

Employee Spouse / Domestic Partner

Employee Spouse / Domestic Partner

Employee Spouse / Domestic Partner

Employee Spouse / Domestic Partner

Dependents

Dependents

Dependents

Children

Dependents

Dependents

This video shows how to manually add a member into the sponsor portal.

Using the My Health Membership Eligibility File

Download My Health Blank Eligibility Excel File

Upload MY HEALTH Completed ELIGIBILITY EXCEL FILE

Using the My Health Membership FORMS to add Members

Primary Member Eligibility FORM

Fill out The First Form for Individuals

My Health Membership Primary Member / Employee Eligibility Form

Spouse or Domestic Partner Form

Fill out The First Form for Spouses or Single Dependents

My Health Membership Primary Member / Employee Spouse or Domestic Partner Eligibility Form

Dependent 1 Eligibility Form (18-25 year-olds)

Fill out The First Form for Dependent #1

My Health Membership Primary Member / Employee Dependent #1 Eligibility Form

Dependent 2 Eligibility Form (18-25 year-olds)

Fill out The First Form for Dependents

My Health Membership Primary Member / Employee Dependent #2 Eligibility Form

Child 1 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #1

My Health Membership Primary Member / Employee Child #1 Eligibility Form

Child 2 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #2

My Health Membership Primary Member / Employee Child #2 Eligibility Form

Child 3 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #3

My Health Membership Primary Member / Employee Child #3 Eligibility Form

Child 4 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #4

My Health Membership Primary Member / Employee Child #4 Eligibility Form

Child 5 Eligibility Form (Under 18 years-old)

Fill out The Form for Child #5

My Health Membership Primary Member / Employee Child #5 Eligibility Form

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