JATC Accident Medical Enrollment

1. Complete the Enrollment Form choosing the benefit options that best meet the needs of your JATC classes.
2. Choose the Coverage Option for your Local:
   • a. Option 1 – Excess Plan 1 (not available in ID, ME, OH, OK,OR SD)
   • b. Option 2 – Primary Plan 2
   • c. Option 3 – Primary Plan 3
3. Select:
   • a. No Weekly Indemnity
   • b. Or $200 Weekly Indemnity
   • c. Or $400 Weekly Indemnity
4. Calculate the annual premium for your Local (policy minimum is $150.00) and mail the completed, and signed Enrollment Form to:
   • Mass Benefits
     PO Box 828
     Annandale, VA 22003-0828

Questions?

Contact Theresa Willett
e-mail: twillett@massbenefits.com
or call 1-800-221-3083.

Download Enrollment Form