You can always press Enter⏎ to continue
Schedule Enrollment Form
Hi there, please answer the following to complete enrollment with your expert enrollment team. If at anytime you need help, reach out to teresa@mi-benefits.com for assistance.
9
Questions
START
1
Hello, Can you please tell us your name?
Nice to meet you!
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Where do you work?
This will help us stay organized and be able to help you more efficiently during your enrollment.
COMPANY NAME
Previous
Next
Submit
Press
Enter
3
Are you or your dependents medicare eligible?
YES
NO
Previous
Next
Submit
Press
Enter
4
In order to go through Medicare Enrollments, you must first enroll in Part A & Part B. We will also need a copy of your ID card in order to move forward. Upload your file here.
Need help with enrolling in medicare? Check out mi-benefits.com/medicare for more information.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
Previous
Next
Submit
Press
Enter
5
With ICHRA, medicare is better than ever! find out more with your enrollment expert.
Previous
Next
Submit
Press
Enter
6
Have you logged in to set up your Zorro account?
The Zorro platform will be your selection tool to allow you to shop your benefits. Find out more on your HUB! visit mi-benefits.com/hub
YES
NO
Previous
Next
Submit
Press
Enter
7
Have you already selected benefits?
this can be done in the Zorro section platform, check out the details on the HUB!
YES
NO
Previous
Next
Submit
Press
Enter
8
That's OK, it is recommended that you complete dependent information prior to the enrollment counselor meeting in order to have enough time to make benefit decisions.
Need help with logging in and knowing what information to have ready? Visit your benefit hub at mi-benefits.com/HUB to learn more!
Previous
Next
Submit
Press
Enter
9
Way to be on top of things! Now select your enrollment time below and get ready to finalize this year's open enrollment.
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
9
See All
Go Back
Submit