Demonstration Version
November 8, 2005
Great-West Online Services for Plan Members: Registration
Where can I find my Plan Number and ID Number?
Explanation of Benefits
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Great-West Benefit ID Card
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If you are currently a Great-West Group Benefits plan member, please fill out the form below to begin the registration process.
Step 1 of 3
Group Benefit Plan Information
You can find this information on your Great-West Benefit ID Card or on any Explanation of Benefits received from a previous claim and/or claim payment.
Plan Number
ID Number
(No spaces or hyphens)
Member Information
First Name
Middle Name
(optional)
Last Name
Date of Birth
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
(YYYY)
Email Address
Postal Code
(
Which postal code do I use?
)
Dependant Information (Spouse/Partner or Child)
If you have a spouse/partner or child covered under your benefit plan, please enter below any one of their birthdays and their relationship to you. This information will help us verify your identity.
If you do not have any dependants, please continue by selecting "Next Step".
Relationship
Date of Birth
Relationship
Spouse/Partner
Child
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
(YYYY)
CANCEL
NEXT STEP
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