1-800-868-5200 (TRS 711)Mon., Tue., Thu., Fri.: 8 a.m. to 6 p.m. Wed: 10 a.m. to 6 p.m.
Small group employer application (pdf, 160 KB)
Large group employer application (pdf, 213 KB)
ACH form (pdf, 48 KB) Complete and mail this form to us for automatic withdrawal of your premium payments
Member transaction form (pdf, 338 KB)Use this interactive, printable application to enroll employees or change or end coverage for an employee.
Employer tools enrollment form (pdf, 114 KB)Use this form to secure access to Employer Tools on our website
One Chestnut Place, 10 Chestnut Street, Worcester, MA 01608
1-800-868-5200 (TTY: TRS 711), Mon., Tue., Thu., Fri.: 8 a.m. to 6 p.m. Wed: 10 a.m. to 6 p.m.
Notice of non-discrimination (pdf)
For information in other languages:
Anonymous Compliance Hotline: Call our Compliance Hotline to report any concerns you may have regarding compliance, fraud, waste or abuse. You can call the Hotline 24 hours a day, seven days a week. All calls are anonymous and confidential.