Fellow Travelers TMF Election

Please enter your information to enroll/disenroll into the Fellow Travelers benefit plans. If you want the benefit, make sure to select the plan you want. If you do not want the benefit, select "Waive". IF you are CURRENTLY enrolled and "Waive" is showing, you will be REMOVED from the insurance.

Name of company you are employed
Your Physician's name
Please choose the date the insurance "turn on" / go into effect. Effective dates can ONLY be on the first day of the month (i.e. No mid-month effective dates).
Clear Signature