LazBoy Columbus Client Portal

La-Z-Boy Columbus Benefits Enrollment

Complete this form to enroll in your benefits for 2026

Enrollment Information

Enrollment Type

Pay Schedule *

Employee Information

First Name *

Last Name *

Email *

Employee ID

SSN

Date of Birth

Date of Hire

Gender

Male

Female

Marital Status

Single

Married

Phone Number

Street Address

City

State

Zip

Location

Medical Coverage - Anthem

I elect to enroll in medical coverage

Dental Coverage - Anthem

I elect to enroll in dental coverage

Vision Coverage - Anthem

I elect to enroll in vision coverage

Dependents

Authorization

I authorize my employer to deduct from my wages the premium, if any, for the elected coverage. I understand that certain payroll deductions will be made on a pre-tax basis. I also understand that evidence of insurability may be required for coverage to become effective.

I confirm that all the information I have provided is true and accurate to the best of my knowledge. My elections will remain in effect until next Open Enrollment and they cannot be changed during the plan year, unless I experience a Qualifying Life Event.