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MTVCPA Enrollment
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Add Dependents at No Extra Cost
Protection+ has you automatically enrolled in AME’s GAP/Hospital Indemnity and Accident Coverage. You can add a family member (dependent) to your GAP/Hospital Indemnity coverage and Accident Plan at no extra cost!
Add Dependents?
Yes, I would like to add dependents
Please add dependent information below
*
Protection+ HI
Change to Hospital Indemnity?
Change my Protection+ GAP to Protection+ Hospital Indemnity
What Happens Next
Now that you’ve enrolled in Protection+ the AME team will be sending you an email link for your access to your AME Dashboard. You can use the Dashboard to check plan information, access your digital ID Card and link up with Allied Wellness. Allied Wellness will also be reaching to you post enrollment as well.
Waive Out Option
I’m not interested in enrolling in Protection+ during this enrollment period. I understand that this plan will be little to no net cost to me and most likely it could result in more net pay for me. I’d like to waive out of Protection Plus for this plan year.
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