Benefit Plan Enrollment & Change Form
If you are an eligible participant in a Plan, you may enroll in the Plan in one of two ways.
You may print, complete and mail a hard copy form; or you may complete the electronic version of the form below, and submit it to The Employee Benefit Service Center via email at customer.support@ebscenter.com.
Click here for the Benefit Plan Enrollment Form, a Printer Friendly version of this form which will open in it's own window.
Click here for the Benefit Plan Change Form, a Printer Friendly version of this form which will open in it's own window.
Print the form to your own printer. Note: You may need to adjust the size (percentage of enlargement/reduction) of the image, depending on your printer's configuration, to make the form fill the page properly.
