group administrators my workspace

Use this form to request access to the Employer Center site if you are an Authorized Administrator. If you already registered and have forgotten your password, use the Forgot Password link. Please allow up to 10 business days to receive your registration confirmation email. For immediate registration call us at 1 (800) 505-6801, Monday-Friday 8:00a.m.-5:00p.m. PT. Note: This Access Request form is for Group Administrators to view and make changes on behalf of your organization. If you are looking to register for your personal account, please go to www.regence.com/member/registration

Group name*

Group ID*

In which state was your Regence plan sold?*

ID OR UT WA

First name*

Last name*

Email address*

Phone number*

Number of enrolled employees*

please choose 1 - 50 51 - 99 100+ Not Enrolled Yet Association

I would like Online Enrollment and agree to make all enrollment and eligibility updates via Employer Center. NOTE: If you are sending eligibility files you are ineligible for Online Enrollment.Learn more Yes No

I would like Online Enrollment and agree to make all enrollment and eligibility updates via Employer Center. NOTE: If you are sending eligibility files you are ineligible for Online Enrollment.Learn more Yes No

I would like Online Reporting Yes No

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