BSG Inc

Add Employee

Plan admins: Submit one form per employee. Confirm the Company Client ID and organization using your BSG portal dashboard.

Enter the employee’s legal name, personal email address, cell phone, hire date and requested benefits start date. Use MM/DD/YYYY for date of birth. Enter your name as the administrator submitting the request.

Ask the employee to watch for BSG Support emails and check their junk folder. BSG will provide next steps as processing is completed and portal access is released. Submitting this form does not confirm insurance enrollment or coverage.

Questions? [email protected] | 930-212-3143

Use the employee’s own email address and cell phone. BSG Support will communicate next steps when processing is complete and portal access is released.

Support: [email protected] | 930-212-3143. Please ask the employee to check their junk folder and save BSG Support in their contacts. Submitting this form does not confirm insurance enrollment or coverage.

First Name *

Last Name *

Date of Birth

Enter month/day/year, for example 04/15/1985.

Email *

Phone *

Hire Date? *

Benefits Start Date? *

Organization *

Name of Admin Submitting this Form *

What is the Benefits Program Type? *

ICHRA

BSG SWI

Anything Else We Should Know?

I agree to terms & conditions provided by the company. I agree to receive calls, text messages, and emails from Benefit Solutions Group at the contact information I’ve provided. Message and data rates may apply. Consent is not a condition of purchase. You may opt out at any time by replying STOP or contacting us directly.

Company Client ID *

Shown on your BSG portal dashboard.