Senior Service Medical Plan (provided by contract with) 2026

1. Click ‘Get Form’ to open the Senior Service Medical Plan enrollment form in the editor.
2. Begin by filling out your personal information in the Volunteer Information section. Include your name, Social Security number, and birth date. Make sure to select your marital status and gender.
3. Next, move to the Assignment Information section. Indicate your assignment sponsor and provide details about your mission or entity name, assignment location, and effective dates for coverage.
4. In the Mailing, Email Address, & Telephone Information section, enter your current mailing address along with contact details for during and after your mission.
5. Complete the Contact Person Information section by providing a trustworthy individual’s contact details who can be reached during your service.
6. Review the Post-Mission Transitional Coverage Information and mark your choice regarding this coverage option. Initial where indicated.
7. Finally, read through the Terms & Conditions carefully. Sign and date at the bottom of the form to acknowledge your agreement before submitting it back to DMBA.

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