How to Apply:

Just print the appropriate application form for your group using the links below.

  1. Choose the amount of insurance that best suits your needs.
  2. Complete the application (both pages). Be sure to answer all questions, as an application cannot be processed unless it is complete.
  3. Determine your total premium amount. Make your check for the first quarterly premium payment payable to “Mass Benefits“.
  4. Mail your completed application(s) and your check for the first premium to:

Mass Benefits Consultants, Inc.
P.O. Box 828
Annandale, VA 22003-0828

Please select your group: