Products & Services | Management | Online Enrollment | Providers | Lifestyle Benefits | Newsletter | Blog

Member Enrollment: Wellness

* Denotes Required
Description Enter Information here Format Notes
* First Name  

Required
Middle Initial  

Optional
* Last Name  

Required
* Birth Date  

Required
* Record Type  

A= Add (field not required if full eligibility) 
C=Cancel U=Update

* Effective Date mmddyyyy

Effective date of member required for new members.
It should be the 15th of next month.

* SSN nnnnnnnnn

Subscribers Social Security Number
(optional for Wellness and Legal Services Plan)
* Member Type  

00-Subscriber, 01-Spouse , 02 through 12 - Dependents
Dependent SSN   If this record is a spouse or a dependent ,
this is their Social Security Number
(optional for Wellness and LSP)
* Address   Required
Address Line 2   Optional
* City   Required
* State xx Required
* Zip Code  nnnnnnnnn Dash is not needed (first 5 required)
Home Phone    Optional
Work Phone   Optional

* Group Number

 xxxxxxxxx Required. Assigned by GE PMG

* Termination Date

mmddyyyy Required if record type is 'C'

Branch Code

   Required 

* Benefit Code

 xxxx Optional

Dental Facility

 xxxx Optional

Ortho Facility

 xxxx Optional

Payment Frequency

   A= Annual , M= Monthly. Optional

Premium Amount

 nnn.nn Optional

Vision Facility

   Optional

Fulfillment Code

   Optional

Language

 x Defaulted to English if not provided

* Account Type

 xxxx VISA, MC, AMEX, DISC, ACH, Optional

* Account Number

 nnnnnnnnnnnnn Optional

Routing Code

 nnnnnnnnnnnnn Optional

Expiration Date

 mmyy Optional

Transaction Date

 mmddyyyy Date of Transaction

Email

   Optional
 

 

 
Home | About Us | Management | Contact Us | Products & Services | Testimonials | Online Enrollment | Providers | Lifestyle Benefits | Newsletter | Blog
 
2008 © All Rights Reserved Decisive Business Solutions, Inc.

Web Site Developed & Hosted by: