New Hire Enrollment Forms

Enrollment Deadlines: Your employer determines how long you have to enroll in benefits. Most give you up to 60 days from your hire date, but some may have a shorter deadline. If you’re unsure, check with your HR team to confirm your enrollment deadline.

Steps to Follow

1. Select your benefits and add any dependents using the enrollment form below. See how
2. Upload your completed enrollment form via the secure Message Center in your PEHP account. See how

Enrollment Form