New Hire Service Form

  • Enter your company name here.
  • Employee Information

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

If you are a client of Elite-VB and use Colonial Life as your carrier, we care about your new hires.  Letting us know you have new hired employees allows us to keep you in compliance with Section 125 as all pre-tax benefits must be offered to ALL employees…equally and fairly.  Just fill out the form and we will contact them and let you if they enroll prior to the eligibility date.  If you have questions, please do not hesitate to call Pamela Whitfield (District Manager) at 907-274-0227.

Please list any new employees hired within the last few months and their HIRE and ELIGIBILITY DATE FOR COVERAGE. If your company has multiple locations, please indicate the work location for each employee.