Click on the enroll now button to begin your application. You’ll start by entering some basic information about your business.

You’ll also need to provide some information about yourself and each of your eligible employees. Save time by gathering this information and filling out the Employer Application Census in advance. You will need information such as employee birthdates, social security numbers, emails and addresses.

HealthSource for Employers also requires you to upload the most recent Form 941 (Quarterly Tax and Wage Report). Click here to view a list of documents you can use if your group isn’t required to file a Tax and Wage Report or you haven’t been in business long enough to complete the report.

Click here to start the application. Click here to find a broker to help you with the application.


Would you like a Business Engagement Specialist to complete the application?

We will be happy to complete the application on your behalf. Please call us at 1-855-683-6757.

You can get a head start by filling out the forms below.