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Employee Application

2017 Online Application

Before you start your application, review 2017 health plans and rates using the 2017 Employee Shopping Tool (Excel). 

Completing the Employee Application Online

  1. Have the following information available:
    • Employer's unique identifier: You must enter this identifier to complete the online form. Ask your employer for this identifier.
    • Dependent social security number (if applicable).
    • Medical plan selection and dental plan selection (if applicable).
  2. Create a unique one-time only user name.
  3. Complete the application whether waiving or enrolling in employer sponsored coverage.
  4. Submit and log out.

Helpful tips for using the online application:

  • Use a recommended browser: Firefox or Google Chrome on a desktop or laptop computer
  • View a how to video for help with completing the application
  • Complete each page within 30 minutes to avoid timing out of the system
  • If a paper copy is desired, print each page as you complete it

Submit the 2017 Employee Application Online

MNsure is committed to accessibility and provides reasonable accommodations to qualified individuals with physical or mental disabilities. If you have a problem accessing this application, please submit your specific request for reasonable accommodations to AEO@MNsure.org. We appreciate your interest in MNsure.

Paper Applications

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