STEP 1: Download the CoOp Membership Agreement by clicking the first button below and saving it on your desktop or in a folder. The form is an interactive PDF which may be filled out electronically before clicking “Submit Forms Here” button at the bottom of this page. If you prefer, you may download, print, fill it out by hand, and scan before submitting.
STEP 2: Pay your annual CoOp Membership Fee by clicking the second button.
STEP 3: Click to download all remaining forms: Employer Group Information Form, ACH Authorization, W-9, Employer Freedom Plan Enrollment Application, and the Cost Calculator. Save them on your desktop or in a folder. The forms are interactive PDFs and may be completed electronically, or if you prefer, you may print, complete, sign all forms before submitting them by clicking the “Submit Forms Here” button below. Please Note: the W-9 must be printed, signed by hand, and scanned before submitting. The ACH Authorization must include a cancelled check.
STEP 4: Once you’ve completed and signed all forms, you’re ready to upload them. Click the “Submit Forms Here” button, which will redirect you to the Regional Care, Inc. portal. Click the “Add Files” button, select all the files you want to upload, and click the Open button. Fill in your name, email address, and any comments you want to add in the pop-up window, and click Ok. Then click the Upload button to begin the quick uploading process. A small window will briefly appear at the upper right to notify you when your upload is complete.
Self Employed Enrollmentgaryf2020-04-28T22:08:32+00:00