Please complete the fields so we can find you in our system and securely verify your identity.

We require this information, because we are bound by federal HIPAA and HITECH regulations to rigorously protect your personal health and benefits information -- at the same level of privacy provided by your doctor.

Enter the first and last names as they appear in your organization’s official records.

Enter your date of birth in the mm/dd/yyyy format.

If you are a dependent, please enter the identification number that corresponds to the primary in the family.