Massachusetts 2026

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The document outlines the checklist and requirements for submitting a Small Group Employer Application to Tufts Health Plan in Massachusetts. It details necessary forms, guidelines for completion, and specific information needed for member enrollment, including verification of alternative coverage and pediatric dental attestation. The document emphasizes the importance of accurate and complete submissions to ensure timely processing and compliance with health plan regulations.

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Click ‘Get Form’ to open the Massachusetts form in the editor.
Begin with the Small Group Employer Application. Fill in the Full Legal Name of the Group, Corporate Headquarters Address, and Tax ID accurately. Ensure all fields are completed as this is crucial for processing.
Proceed to Section 1: Tax ID. This is a nine-digit numeric field; double-check for accuracy.
In Section 3, if you choose 'No' regarding waiving the waiting period, ensure that each employee's Date of Hire is filled out on their individual applications.
For Member Enrollment Forms, provide a physical residential address—P.O. Boxes are not acceptable. All forms must be signed and dated at the bottom.
Complete any additional required documents such as the Pediatric Dental Attestation Form and Verification of Alternative Coverage Forms as needed.

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