Individual Enrollment

How to Enroll

As an individual, follow these simple steps to enroll in our program:

• Sign a basic service agreement and pay a nominal setup fee.
• Select one of our medical options and, if you wish, sign-up for short- and long-term disability and life insurance, our 401(k) plan, or flexible spending account plans.
• When you sign up, a portion of the money you typically pay yourself is paid to BCC each month to cover your health insurance premium, a small salary, taxes, unemployment insurance, workers’ compensation insurance and, if selected, other benefits. In many cases, our fee may be deducted on your tax return as an ordinary business expense; you should consult with your accountant or financial advisor regarding the deductibility of our PEO fee.

Medical coverage and any optional benefits you elect take effect on the first of the month after joining our program.

For More Information

To learn more about how you can get quality, affordable medical coverage, please complete this form:

*Your Name (First, M.I., Last)

*Home Street Address

*City State Zip Code

* Home Phone

* Work Phone  Extension

*Email Address

How would you like to be contacted: __ phone  __ email

When is the best time to contact you: __ morning  __ afternoon __ evening

Do you currently have medical coverage? __ yes  __ no

If yes, type of coverage: __ individual __ you + one __ family

If yes, name of insurance carrier:

Current monthly premium: $_______

Renewal date for current medical coverage: __________ (mm/dd/yy)

Renewal increase (if you know): _____

Do you current have COBRA coverage? __ yes  __ no

If yes, date when COBRA coverage will end: ___________ (mm/dd/yy)

Questions or Comments:

*Required information