Enrollment Forms

Member Application for MESSA Benefits

This application is used to enroll in MESSA benefits. Please fill out completely, sign and return to your employer. (Video Tutorial)

Member Application for MESSA ABC Plans 

This application is used to enroll in MESSA ABC benefits. Please fill out completely, sign and return to your employer. (Video Tutorial)

Member Change Form

This form should be used by the MESSA member to add or delete dependents, change address, and/or to delete options. Please fill out completely, sign and return to your employer. (Video Tutorial)

1475 Kendale Blvd., P.O. Box 2560, East Lansing, MI 48826