SHIP Enrollment Form

Enrollment is easy…

You can give your family the extra protection of SHIP in minutes.

  1. Complete the Enrollment Form.
  2. Make sure you check which coverage options you want.
  3. Choose your payment option (Bi-Weekly, Monthly, Quarterly, Semi-Annual and Annual payments)
  4. Mail the application and initial payment for direct bill or authorization form for Payroll Deduction or Monthly deductions from your checking account to: Mass Benefits Consultants, Inc. P.O. Box 828 Annandale, VA 22003-0828

THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A
SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR
MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY
RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES.

Download the enrollment form

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SHIP-ENR-0117