WebEnrollment - My ASP.NET Application

Enter Employer Access code and Subscriber Access Code to access your enrollment data.

Employer Access Code :

SubScriber Access Code :

Subscriber Detail

Subscriber Access code : {{CensusSubscriberList[CurrentInx].subscriber.subscriberAccessCode}}

Self:

First name

Mid name

Last name

Sbscrbr Gender

SSN

DOB {{CensusSubscriberList[CurrentInx].subscriber.dob | date: 'MM/dd/yyyy'}}

Phone nbr

job title

hours worked

marital

HireD {{CensusSubscriberList[CurrentInx].subscriber.hire_dt | date: 'MM/dd/yyyy'}}

Address

city

state

zip code

Add Dependent

First name

Mid name

Last name

Gender

SSN

DOB {{d.dependent.dob | date: "MM/dd/yyyy"}}

Plan Selection:

Medical

Dental

Vision

Life

Effective Date

Date Moved to Eagle

Self

Cov:{{CensusSubscriberList[CurrentInx].subMedicalSelected.coverageCode}}

Cov:{{CensusSubscriberList[CurrentInx].subDentalSelected.coverageCode}}

Cov:{{CensusSubscriberList[CurrentInx].subVisionSelected.coverageCode}}

Cov:{{CensusSubscriberList[CurrentInx].subLifeSelected.coverageCode}}

{{CensusSubscriberList[CurrentInx].subscriber.plan_effective_dt | date: "MM/dd/yyyy"}}

{{CensusSubscriberList[CurrentInx].subscriber.move_dt | date: "MM/dd/yyyy HH:mm"}}

Spouse:{{dd.dependent.dependent_first_name}}:

Selection Submited: {{CensusSubscriberList[CurrentInx].subscriber.submited_dt | date: "MM/dd/yyyy HH:mm"}}

Subscriber Access code : {{CensusSubscriberList[CurrentInx].subscriber.subscriberAccessCode}}

Self:

First name {{CensusSubscriberList[CurrentInx].subscriber.first_name}}

Mid name {{CensusSubscriberList[CurrentInx].subscriber.middle_name}}

Last name {{CensusSubscriberList[CurrentInx].subscriber.last_name}}

Sbscrbr Gender {{CensusSubscriberList[CurrentInx].subscriber.gender}}

SSN {{CensusSubscriberList[CurrentInx].subscriber.ssn}}

DOB {{CensusSubscriberList[CurrentInx].subscriber.dob | date: 'MM/dd/yyyy'}}

Phone nbr {{CensusSubscriberList[CurrentInx].subscriber.phone}}

email {{CensusSubscriberList[CurrentInx].subscriber.email}}

job title {{CensusSubscriberList[CurrentInx].subscriber.job_title}}

hours worked {{CensusSubscriberList[CurrentInx].subscriber.hours_worked}}

marital {{CensusSubscriberList[CurrentInx].subscriber.marital_status}}

HireD {{CensusSubscriberList[CurrentInx].subscriber.hire_dt | date: 'MM/dd/yyyy'}}

Address {{CensusSubscriberList[CurrentInx].subaddress.address}}

city {{CensusSubscriberList[CurrentInx].subaddress.city}}

state {{CensusSubscriberList[CurrentInx].subaddress.state}}

zip code {{CensusSubscriberList[CurrentInx].subaddress.zip}}

Spouse:Child:

First name {{d.dependent.dependent_first_name}}

Mid name {{d.dependent.dependent_middle_name}}

Last name {{d.dependent.dependent_last_name}}

Gender {{d.dependent.gender}}

SSN {{d.dependent.ssn}}

DOB {{d.dependent.dob | date: "MM/dd/yyyy"}}

Plan Selection:

Medical

Dental

Vision

Life

Effective Date

Date Moved to Eagle

Self

{{CensusSubscriberList[CurrentInx].subMedicalSelected.plan_name}} Cov:{{CensusSubscriberList[CurrentInx].subMedicalSelected.coverageCode}}

{{CensusSubscriberList[CurrentInx].subDentalSelected.plan_name}} Cov:{{CensusSubscriberList[CurrentInx].subDentalSelected.coverageCode}}

{{CensusSubscriberList[CurrentInx].subVisionSelected.plan_name}} Cov:{{CensusSubscriberList[CurrentInx].subVisionSelected.coverageCode}}

{{CensusSubscriberList[CurrentInx].subLifeSelected.plan_name}} Cov:{{CensusSubscriberList[CurrentInx].subLifeSelected.coverageCode}}

{{CensusSubscriberList[CurrentInx].subscriber.plan_effective_dt | date: "MM/dd/yyyy"}}

{{CensusSubscriberList[CurrentInx].subscriber.move_dt | date: "MM/dd/yyyy HH:mm"}}

Spouse:{{dd.dependent.dependent_first_name}}:

Selection Submited: {{CensusSubscriberList[CurrentInx].subscriber.submited_dt | date: "MM/dd/yyyy HH:mm"}}