First-Time Member Account Sign-up
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 Date of Birth:
(m/d/yyyy)
Your Home ZIP Code:
Your E-mail Address:
I hereby certify that I am the person named in the First-Time Member Account Sign-up 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 AGREE
I DISAGREE
We noticed there is not an email address on file for this account. In an effort to better service this account we need an email address on file. Select "Go to My Account" to provide an email address now or "Not now" to be reminded again in 7 days."