Medical and Dental Enrollment Application - OGI Actions

The Office of Group Insurance (OGI) uses Medical and Dental Enrollment Application to establish insurance coverage on behalf of a benefited employee.  OGI can complete this form at any time during the year and does not have to wait until open enrollment to do so.

 


To fill out the form, please follow the directions as stated on "Medical and Dental Enrollment Application"

When the document has been updated, OGI can send this document directly to the Division of Statewide Payroll (DSP), by clicking the 'SUBMIT' button. Then the document will be in an 'Awaiting-Release' status.