Username Recovery

IMPORTANT NOTICE TO ALL WEBSITE USERS: ASR's Website is in full compliance with regulations issued by the U.S. Department of Health and Human Services to protect your individually identifiable health information. Therefore, all users must complete this brief validation sign-up process before accessing their coverage information within the Website.

Please enter the Employee's Social Security Number:

Please provide the following information about yourself:

Relationship to Employee:	I am the employee I am a dependent of the employee
Your Social Security Number:
Your Last Name:
Your First Name:
Your Home ZIP Code:
Your Date of Birth: (mm/dd/yyyy)

I hereby certify that I am the person named in the Username Recovery section and that the information I provide is accurate to the best of my knowledge. I understand that my coverage in the plan may be terminated for fraud or misrepresentation, in accordance with the plan language.

I AGREEI DISAGREE