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: required

Please provide the following information about yourself:

Relationship to Employee:

I am the employee

I am a dependent of the employee

required

Your Social Security Number:

required

Your Last Name:

required

Your First Name:

required

Your Date of Birth: (m/d/yyyy)

November 2024 Select a Different Month (Keyboard shortcut: M)

required

Your Home ZIP Code:

required

Your E-mail Address:

required

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

You must agree to the terms shown to continue