Schedule BRIWEB Open Enrollment Survey

1.Employer Name(Required.)

2.Employer Tax ID(Required.)

3.Plan Year(Required.)

Start Date

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

End Date

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

4.Open Enrollment(Required.)

Start Date

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

End Date

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

5.Pick One:(Required.)

Employees enter Open Enrollment data at BRIWEB

Employer enters Open Enrollment data at BRIWEB

6.If employees enter OE data at BRI web, then:

Employer will upload a full eligibility file no later than 5 business days before open enrollment start date

Use existing active population on file at BRI