Member Info

Landing Page

Life Enrollment02

Beneficiaries

Life Enrollment05

CCError

CCSuccess

Maintenance Page

CrossSellRedirect

Hanger Page

SEIU - Maintenance Page

ValidateInfo

ReadResponse

(ExpiryTime)

(TokenError)

(TokenSuccess)

(AccessToken)

(EncryptedMDS)

(DecryptedMDS)

(Productcode)

(Promocode)

(Cellcode)

(Campcode)

(SeiuLanguage)

(Lang)

MemberAgeRangeMarketing

(SpouseOver69UsingInPage)

(MemberOver64UsingInPage)

(MemberOver69UsingInPage)

(MemberOver80UsingInPage)

Change language to: Switch Language: EnglishCambiar idioma: español

Let's get started.

All fields required unless marked optional

First Name

First Name is required

Last Name

Last name is required

Date of Birth

Valid Date of birth is required

Sex Assigned at Birth

Male
Female

Assigned sex at birth is required

SEIU Insurance

Please select a valid product

Accident & Injury Insurance Notice

SEIUMB Representative Enrollment Information

Select your service center:

Please indicate Agent Service Center

Your Representative ID:

Agent ID is required.

Member MDS ID

Member MDSID is required.

Source Code

Agent source code is required.

Sorry! Your age exceeds the plan requirements to enroll for coverage. Contact SEIU Member Benefits for additional help at 866-751-0260

Please note that your age exceeds the eligibility requirements for online enrollment in this plan. To explore your AD&D coverage options, contact SEIU Insurance Operations at 866-751-0260 or email customerservice@seiumbinsurance.com.

Opens in a new windowPrivacy Center
Opens in a new windowTerms and Conditions
Opens in a new windowBusiness Integrity
Opens in a new windowAccessibility

SSO Testing
Promocode: {Promocode} | EncryptedMDS: {EncryptedMDS} | Product: {Product} | Cellcode: {Cellcode} | Campcode: {Campcode} | DecryptedMDS: {DecryptedMDS} | Language: {Lang} | URL: {LangURL} | {EncryptedMDS} | {MarketoURL} |{LanguageSelector} | {SelectLanguage} | {TranslationServices} | {SelectedLangDropdown} | {AgentEnrollment}

(BlockObasi)

(DuplicateTabs)

We're Sorry!

You're viewing the enrollment website from more than one browser or tab. Close extra windows or tabs, then refresh the page. If the issue persists, restart your device.

IMPORTANT: This is a fixed indemnity policy, NOT health insurance

This fixed indemnity policy may pay you a limited dollar amount if you're sick or hospitalized. You're still responsible for paying the cost of your care.

The payment you get isn't based on the size of your medical bill.
There might be a limit on how much this policy will pay each year.
This policy isn't a substitute for comprehensive health insurance.
Since this policy isn't health insurance, it doesn't have to include most Federal consumer protections that apply to health insurance.

Looking for comprehensive health insurance?

Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
To find out if you can get health insurance through your job, or a family member's job, contact the employer.

Questions about this policy?

For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under "Insurance Departments."
If you have this policy through your job, or a family member's job, contact the employer.

(TriAgencyModalJS)

(TestScript)

(MyHiddenValue)

Debugging

A A A

Warnings

validation warnings here.