PDX Benefits · Offline enrollment

This form runs on your computer. Every answer—including company details, people, SSNs and bank details—is included in your encrypted file. It does not upload, email, submit to a carrier, or activate coverage.

Start or reopen your draft

Your .pdxdraft file opens with your passphrase. Keep the passphrase in a password manager or another safe place, separate from the file. There is no reset, and James cannot recover your draft passphrase.

Draft passphrase (at least 16 characters)Confirm passphrase for a new draft or a passphrase change

Changing the passphrase affects future saved drafts. It does not change older files. Use a unique long passphrase; do not enter your email or banking password.

Previously saved encrypted draft

To switch computers, move the HTML tool and your encrypted draft, then enter the same passphrase. Downloads may get a numbered filename: keep track of your newest draft. Nothing autosaves. The form locks and clears after 15 minutes of inactivity; save frequently.

Checking offline support…

Employees & dependents

Use the same family ID to link a dependent with an employee. Include employees declining coverage and leave unknown answers blank. SSNs are optional here; enter them only if James has requested them. Do not enter medical histories.

Bank details, if requested

Include bank details in this encrypted application

Review & return to James

Check all answers. Blank fields remain unanswered. Preparing this file is not a signature, banking authorization, carrier submission, or coverage approval.

I reviewed these answers and am authorized to provide them.

Keep a .pdxdraft for yourself. The separate .pdxenroll final packet is for James to read and cannot be reopened by this applicant form. Use only the restricted return destination James has arranged for your company. Nothing is sent automatically.

Save now; reopen later with your passphrase.