Before you start, please review how Quad Power EMC and Benefits For You LLC handle the information you enter into this form.
What this site does
This site guides you to the medical and dental/vision enrollment portals hosted by the carriers. All personal, dependent, and beneficiary information is collected inside those carrier portals and goes directly to them. We do not receive or store that data.
What we record
Only your confirmation that each enrollment was completed (or waived, with a reason) and your e-signature. These stay in your browser session and are included in the PDF summary you generate at the end.
Waiving coverage
If you choose to waive medical, dental, or vision coverage you must provide a reason. This is required by your employer for open-enrollment records.
Who receives your PDF
At the end of the flow you'll generate a PDF summary intended for you, your employer, and the Agent of Record (Kendy Wheeler, 812-584-5051, kendy3527@aol.com). You choose when and to whom to send it.
Your rights
You can stop at any time. You may request deletion of any records you've shared by contacting the Agent of Record.
Security reminder
The carrier portals collect sensitive information including your Social Security Number. Do not complete enrollment on a shared or public device.