MESSA Enrollment Request

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IMPORTANT - By providing the information below, the TCAPS benefits department will create a MESSA profile for you. Within 2-3 days of submitting this form, you will receive an email directly from MESSA with instructions on how to create a member account and enroll in coverage. For additional questions or concerns, please contact the benefits department directly. Submission of this form is only required once.

TCAPS ID number: *

First Name: *

Last Name: *

Preferred email to receive enrollment information: *

Are you currently enrolled in a MESSA product with TCAPS or other school district? *

Yes

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