Employee Self Registation - Step 1

This is the first of a multi-step process to gain access to the enhanced features of this site. We will be using the information you provide below to validate your eligibility for those services and to start setting up your account. Once you submit this form you will receive an e-mail (to the address you specify below) containing a link, clicking on this link will bring you to the next step in your registration process.

Shows required fields.

  • Required information is either missing or not valid. Please review the whole form and correct the fields highlighted in red.
Please obtain from your employer.
Located on your Horizon Blue Cross insurance card.
Requirements: 8 or more Characters, 1 Capital, 1 Lowercase, 1 Number & 1 Special.
Read the Terms of Service before agreeing.