All Dependent Verifications & Working Spouse Surcharge Forms MUST be received by the Benefits Department no later than May 31st. See "Adding A Dependent" section below for more information on Dependent Verifications.
REMINDER: Your login is your Team Member number and your default password is the last 4 digits of your SSN.
Interested in saving money on your weekly medical premium? Participate in the Wellness Program and you can save up to $900 off your annual medical program contribution. Complete the requirement below in order to start receiving your weekly discount. *This discount is unavailable for the Bronze plan.
Complete a Preventative Exam: Earn credit by completing your regular preventative exam. There is NO FORM this year. Blue Cross is notified when your doctor submits the claim to Blue Cross.
New! The Benefits and Pharmacy Teams have partnered together to make the wellness process more convenient for Team Members. Eligible Team Members and their enrolled spouses can now go to any United Family Store with a pharmacy and have their wellness screening performed. This would qualify as your regular preventative exam. The screenings will be every Wednesday at your United Family pharmacy of choice. Click here to set up an appointment. **Due to the current COVID-19 pandemic, all pharmacy appointments are suspended until June 1st
Adding A Dependent
If you are enrolling any dependents on your insurance, you must verify their dependent status in order for them to be covered on the insurance. You can send in one of the following to verify dependent children or step-children:
First page of 1040 Tax Form (if claimed on taxes)
Court Documents for legal guardianship
You can send in one of the following to verify your spouse:
First page of 1040 Tax Form (if filed jointly)
Verification of your dependents MUST be received within 60 days of the effective date of coverage. If the verification is not received, your dependents will not be covered on the plan. You can fax your documentation to (806) 791-6341; please include your Team Member number and name.
Working Spouse Surcharge
If you are covering a spouse on the Medical Plan you must complete the Working Spouse Surcharge Form (located under Useful Website Links and Forms). No spouse will be eligible or be enrolled in a Medical Plan until this form is completed and returned.
Life Event (Qualifying Event) Changes
Annual Enrollment is the only opportunity to elect, add a dependent or change your coverage throughout the year, unless you have a Life Event Change. If you have any questions, refer to the Enrollment FAQs Life Event section located under the Benefits tab above.