We’re hard at work adding this functionality into our Portal directly so that you see your changes in real time! In the meantime, rest assured that our team will receive and execute all form submissions within a business day.

Add an Employee as a UPC Member

Your Name(Required)
Employee Name(Required)
Employee Address(Required)
MM slash DD slash YYYY
Effective date defaults to the first day of the upcoming month. For example, if you are submitting a new enrollment between January 1 – January 31, the enrollment will be effective February 1. Enrollments cannot be submitted retroactively. If you have any questions, please contact your dedicated account manager
Please enter a number greater than or equal to 1.