By Clicking 'OK' below you are confirming the following is true:
1. That you understand that this form is only for Groups requesting NC State Health Plan benefit administration system access or are in a role that is related to supporting the Plan on behalf of their Group's employees.
2. You are a current employee of the Group selected and are actively working in the role(s) selected on this form.
3. You agree to be included on the Plan's email list to receive HBR Updates/Alerts.