Encore Rehabilitation, Inc. 2023 Open Enrollment

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

All benefit eligible employees have been mailed a letter summarizing the benefit plans in which you are currently enrolled. Please review this summary of your currently elected benefit plans before completing your elections for the new plan year. You may also contact the Human Resources Department at (256)350-1764 for confirmation of your current benefit elections.

If you would like to review a detailed benefits guide before you begin your open enrollment, click the link below:

2023 Encore Benefit Guide

New Plan Year: June 1, 2023 - May 31, 2024

Due to the Affordable Care Act YOU ARE REQUIRED to indicate your election for each type of coverage

Employee First Name *

Employee Last Name *

Employee Badge Number (5 digit number used to clock in).
*

Email Address *

List email account that you will check for enrollment confirmation and for any follow-up contact from Human Resources

Daytime Telephone Number *

Enter 10 digit number, include area code, no dashes (example 2563501764)

Does your mailing address and/or contact phone need to be updated? *

Address is used for mailing W-2 form, open enrollment info. and other correspondence

Yes

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms