Add An Employee As A UPC Member

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

Employer Name(Required)

Your Name(Required)

First Last

Employee Name(Required)

First Last

Employee Email(Required)

Employee Phone

Employee Address(Required)

Street Address City State ZIP

Effective Date(Required)

Effective Date defaults to the first day of the next month. If it is past the 25th of the current month, it will be the first day of the next full month. If an addition occurs on March 24, it will be effective April 1. If an addition occurs on March 26, it will be effective May 1.

Number of Pets Enrolled(Required)

Please enter a number greater than or equal to 1.

Employee ID

Work Location