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Employee Enrollment / Change Form
Initial GroupCOBRANew EmployeeChange (complete change section
on reverse side)
GROUP NUMBEREMPLOYER Reopen EnrollmentBenefits Administered by:UMR ENROLLMENT SERVICES
PO
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How to fill out group number
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Locate the section on the form where group number is requested.
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Who needs group number?
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Individuals who belong to a particular group or organization.
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What is group number?
Group number is a unique identifying number assigned to a group of individuals or entities.
Who is required to file group number?
Any entity that has been assigned a group number by the relevant authority is required to file it.
How to fill out group number?
Group number can be filled out by providing the assigned number in the appropriate field on the form.
What is the purpose of group number?
The purpose of group number is to identify and track a specific group of individuals or entities for administrative or regulatory purposes.
What information must be reported on group number?
The group number itself along with any additional information required by the relevant authority.
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