Print this page

Registration

New Employer Registration

As an authorized employer, you will be able to view and access valuable account and medical information online.

Enter employer information in the form below and then click the Register button.

* Indicates required information

Employer Information
Do not include the "-" when entering the Federal ID.
(ie. CI999S or 9999HP)
Contact
/ /
(Area Code & Number)
User ID & Password
User ID may contain at least 1 and any of the following (space . @ _ -). Example: John Smith or j_smith@my-address.com
Password must be a minimum of 8 characters with at least 1 number and 1 upper case letter.
Password Recovery Security Questions

You will need to select and answer a minimum of 4 security questions. The questions will be randomly displayed in the event you forget your password. After you enter the question correctly you will be allowed to reset your password.

Select 3 unique questions and enter one of your own questions below.

  Security Question Answer
* 1:
* 2:
* 3:
* 4: