BeniComp Select Signature Request

Please confirm your options below

Group Name
Group Number
Product Selection

We’re excited to offer you two great BeniComp Select options! You may upgrade to BeniComp Select Signature for some or all of your executives.
BeniComp Select Signature Election

BeniComp Select Signature Election BeniComp Select Signature upgrade for all BeniComp Select members BeniComp Select Signature upgrade for only some BeniComp Select members
Number of members who will have BeniComp Select Signature
Member 1 Name Member 1 Name First Last
Member 2 Name Member 2 Name First Last
Member 3 Name Member 3 Name First Last
Member 4 Name Member 4 Name First Last
Member 5 Name Member 5 Name First Last
Member 6 Name Member 6 Name First Last
Member 7 Name Member 7 Name First Last
Member 8 Name Member 8 Name First Last
Member 9 Name Member 9 Name First Last
Member 10 Name Member 10 Name First Last
Please upload a list of the members to enroll in BeniComp Select Signature
Census Change Information

If you need to make changes:
Log into the BeniComp Admin Portal to add, remove, or update participants.

Need help making a change?
How do I add or term a participant?
Contact Information

Thank you for completing the renewal process. Please update communication preferences below to receive a confirmation receipt.
Preferred Contact Name Preferred Contact Name First Last
Preferred Contact Email
Preferred Contact Phone Preferred Contact Phone - ### - ### ####