Enrollment by Payroll Deduction

Payroll Deduction:

1. Complete the attached Enrollment Form and mail to Mass Benefits.
2. Either Complete the Direct Deposit Form and give it to your payroll office - or - use the bank account and routing information to set up the allotment through your online employee account.

Your coverage will begin on the first day of the pay period of the first allotment payment and receipt of your application.