LINECO Family Enrollment Form

BEFORE YOU BEGIN

Have the following documents on hand while completing the online enrollment:

  • A certified copy of your marriage certificate if you are married and enrolling a spouse
  • Copies of birth certificates for children you are enrolling
  • A copy of all pages of divorce decrees
  • Copies of all pages of court orders pertaining to health coverage of a child or children

The above documents can be attached to your online submission. If you are unable to upload them as attachments, please mail them promptly to the following address. Please be sure to include the enrollment key that will be emailed to you when you complete the online enrollment.

LINECO ENROLLMENT DEPARTMENT
821 PARKVIEW BOULEVARD
LOMBARD, IL 60148

Start a New Enrollment Form

Terms of Use/Disclaimer

Update Saved Enrollment Form

Recover my enrollment key.