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Secure Document Upload

Upload Group Enrollment Documents

For Groups with Group Numbers of 5 or 6 Digits 
(Groups Headquartered in Minnesota, North Dakota, South Dakota and Wisconsin)

File Info

File Types
  • .bmp
  • .gif
  • .jpg
  • .jpeg
  • .pdf
  • .png
  • .tif
  • .tiff
  • .xls
  • .xlsx
  • .csv

File Count

You can attach a maximum of 15 files.

File Size Max
  • 15 MB (each document)
  • 28 MB (all files combined)

Need Help?

Call the Employer Service Center
1-800-936-6880

The following errors occurred:

Please enter your information below. Attach the enrollment document(s) you would like to securely submit to Medica's enrollment department. Upon submission you will receive an e-mail confirming receipt.

    Only Medica’s Group Enrollment/Change/Cancellation Form and Medica Approved Enrollment Spreadsheets are accepted.
  1. Group Enrollment/Change/Cancellation Form (for plans with a six-digit group number)
  2. Group Enrollment/Change/Cancellation Form (for plans with a five-digit group number)

*Please make sure there are no forward or backward slashes in document file names or any fields*

Note: Please retain the original document(s) and the receipt page for your records. You do not need to mail or fax these documents to us.

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