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Employer Account Request

Complete the fields below, then make a note of the username and password you choose. You'll need them to log in to your account once we activate it. Click any help symbol for help.

Your Privacy is Important. Priority Health has a strict Privacy Policy. We will not share your account information with others.

(required) Indicates required information

Employer Information
Company Name help
as it appears on Remittance Advice
Group Number
Sub Group Numbers
(Separate Multiple Sub Groups with a ",")
Address Line 1 (Street Address) help
Address Line 2
Zip Code
Office Contact/Manager help

User Information
First Name
Last Name
Your roles - check all that apply help
Executive (owner/CEO, CFO)
Administrative (office mgr, acct/bookkeeper, admin contact)
HR (benefits manager, HR manager, HR specialist)
Email Address help
Phone help
( ) - ext.
( ) -
Username help
(6-32 characters)
Password help
(8+ characters, at least 1 number, case-sensitive)
Password Confirmation help
Tools for Employers
Select all the tools that you would like associated with your account. Click any tool name to read a description.
Employee Inquiry
ID Card Request
Life just got a little easier