How to Enroll

A. Select your Provider Facility (

B. Complete Enrollment Form. Complete all requested information.

C. Choose payment method:

1) Payroll Deduction – The enclosed Direct Deposit Sign-Up Form contains the

Dental Bank Account Number and Bank Routing number needed to set up your


2) Monthly Check Service – include the Monthly Check Service Authorization

3) Quarterly Direct Bill – upon receipt of your Enrollment Form, we will mail you an invoice.

D. Mail application and form(s) to:

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


Download Enrollment Form