CoverWell Service
Provider Information

  • Use this form to add service providers to your CoverWell Service Provider Roster
  • Submit one form per service provider.
  • Please include this with your New Employee/New Contractor Forms when onboarding employees and contractors. 
  • IMPORTANT: Only service providers who have been approved and entered into the CoverWell system are eligible to have their services covered under a CoverWell policy.