Affiliation/Enrolment Form

To access the affiliation form please click here.

We remind all individuals that it is your responsibility to enroll in a health insurance plan within 31 days of a qualifying event (entry on duty, marriage/divorce, birth of a child/adoption, recognition of a secondary dependent, change of duty station, etc...) If your organization uses UMOJA please do the necessary in Employee Self Service (ESS). Click on the link to access the UMOJA Self Service job aid for health insurance. If your organization does not use UMOJA  please complete, sign and send the affiliation form to the relevant Human Resources Officer.

Prior to requesting affiliation we strongly encourage everyone to read the Internal Rules and to view the page on this website dealing with the topic of Affiliation.

We would like to remind to existing members that it is your responsibility to advise us of any changes in family structure, such as marriage, newborns or divorce.