Register for Benefits Portal Account

All fields are REQUIRED. Login instructions will be sent to your email address below.
THIS SITE REQUIRES JAVASCRIPT ENABLED.

Company Code:
Company code is provided by your manager or HR Department.
Please contact them if you do not have this code.
     
     
First Name:
Last Name:
  

Email Address:

Email Address (confirm):
If you don't have an email account click here:
Password:
Password (confirm):
  
     



INSTRUCTIONS

1. Fill out this form completely and click
"Register Benefit Portal Account"
2. You will receive an authorization
email at the email address you
listed above.
3. In the email is an approval URL.
Type the URL into your web
browser and you will be approved.
4. At the login box that displays,
type in your email address
and password above.
You will have access to your
benefit portal.

Sign up today for access to your
employee benefits portal. With this
account you can:

  • Access benefit plan information
  • Access important employee forms
  • Enroll in, or update your benefits
  • View other HR related information

 

 
ATTENTION: This form can only be used for registering for a benefit portal account. You are not authorized to use this page if you are not an employee of an enrolled company.

TERMS OF SERVICE | PRIVACY POLICY | COPYRIGHT
Copyright © 2010 BrokerSuite, LLC, All Rights Reserved.
"MyBenefitsCount" is a trademark of BrokerSuite, LLC.