MECA Dental/Vision Enrollment

MECA Member Vision and Dental Enrollment
Download the census form, Group Application and EFT form using the links below.
Click on the Blue Links to download the forms:

MECA census form

MECA Group Application

Altus EFT form
* Fill out the top section of the Application form.
* List the details for everyone to be covered under the plan in the Excel Group Census form.
* Fill out the required EFT form
Once you have filled out all three, please upload them below:
Cancelof
Company contact information:
Company Name
Company Contact Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please submit your form and our team will be in touch!
Approval - For MECA use only
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MECA Member Vision and Dental Enrollment