Sedera Health Completed Enrollment Notification and Spreadsheet Transmittal

Completed Enrollment Notification and Spreadsheet Transmittal
Congratulations on successfully completing your Sedera Health Enrollment on your case!

To proceed, please upload your completed Sedera Census and submit securely in this form.

Additionally, please remember that YOU are responsible for your deduction report. We recommend using your Enrollment Director to handle all of this for you, or manually utilizing your census to create your own deduction report.
Writing Affiliate's Name*

First NameLast Name
Affiliate's Email*
example@example.com
Was this case processed by David Goddard, our Enrollment Director? If so, David will get your deduction report to you and be responsible for timely issuance. He will receive a 10% transmittal split for his work. The Writing agent(s) will receive the remaining 90%*

YesNo, I did this myself.
Affiliate's Phone Number*

Area CodePhone Number
GROUP/COMPANY name enrolled*
Date your enrollment was finished*

MonthDayYear
Date
Effective Date of these member applications*

MonthDayYear
Date
How many EMPLOYEE applications are on this spreadsheet? *
What type of Enrollment is this?*

New AccountOpen Enrollment in an Existing AccountNew Hires in an Existing Account
Upload your Census or PDF applications here:*

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