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Enroll a Group!

Broker/Agents Pick Your Enrollment Method

ONLINE COMPLETION (Interactive Forms):

  • Populate interactive forms online, sign, and save form files.
  • Click the “Submit Forms Here” button at the bottom of this page and attach all completed forms to your email.

OR

PAPER METHOD WITH SCANNING or MAILING VIA USPS:

  • Download all required forms and print them on paper.
  • Fill out and sign all forms.
  • Scan all pages and save files.
  • Click the “Submit Forms Here” button at the bottom of this page and attach the scanned files to your email.
  • NOTE: You may also mail the paper forms via USPS at this address: SB/A Enrollments, P.O. Box 893, Lafayette, CO 80026
    Please save a copy of all paper forms mailed.

OR

CENSUS METHOD:

  • Obtain a “Census” from the Employer by providing the census template to the Employer for completion by HR.
  • Complete all other required interactive forms online, sign, and save form files.
  • Click the “Submit Forms Here” button at the bottom of this page and attach the census and all other forms to your email.

Note: All methods will submit your information to the SB/A CoOp where your enrollment package will be prepared for submission to Regional Care, Inc.

Step 1

CoOp Membership Agreement
for the Employer

Download CoOp Membership Agreement
and complete form.

Step 2

Employers May Pay Their
CoOp Membership Fee Below

A CoOp Membership is $24.00

Step 3

W-9, SBA CoOp
Employer Application,
Group Information Form,
ACH Authorization Form,
Employee Enrollment Application,
Employer Freedom
Plan Checklist

Download forms and save them to your desktop.
Complete forms and submit.

Step 4

Group Employer Census
Eligibility Template

Download form and save it to your desktop.
Complete form and submit.

  • STEP 1 Detail: Download the CoOp Membership Agreement and save it on your desktop or in a folder. The form is an interactive PDF and can be filled out electronically. If you prefer, you may print, fill it out by hand, and scan before submitting. Click the “Submit Forms Here” button at the bottom of this page and attach the files to your email.

  • STEP 2 Detail: Assist your business owner/employer in paying their CoOp Membership Fee here.

  • STEP 3 Detail: Download the forms, complete, and sign. The forms are interactive PDFs and may be completed electronically, or if you prefer, printed, completed by hand, and signed. Provide the “Employee Enrollment Application” to each employee for completion. Click the “Submit Forms Here” button at the bottom of the page and attach all files to your email. Note: the W-9 requires a wet signature. 

  • STEP 4 Detail – If you are choosing the Census Method: Download the Group Employer Eligibility Template. Provide this Excel format template to the HR department for populating a census before submitting it in addition to all other required forms. Click the “Submit Forms Here” button at the bottom of this page and attach your files (including the completed census) to your email . 


Submit Forms Here


Attach all completed forms to your email.