Teamsters LTD

Teamsters Long-Term Disability

If you are within your initial 30 day hire period, please answer the questions below so that we can send the Long-Term Disability document to the email address you provide on this form.
Please refer to this document for a benefit summary and premium rates.

After the initial 30-day new hire enrollment period, enrollment in Long-Term Disability is a process which will require the completion of evidence of insurability forms and approval by the plan. If you would like to initiate an application to do so, please contact the Benefits team for assistance.

Please confirm your benefit eligibility on the benefits webpage before completing this form.

Also be sure to review the plan details on the website prior to enrolling.
First Name
Last Name
Email
Please use your City email address if you have one. example@example.com
Department
What would you like to do with your long-term disability benefit?
Please verify that you are human
Next Steps

After you click the Submit button below, we will send the Long-Term Disability document to the email address you provided on this form. It will come from "City of Cambridge Benefits Team via Adobe Acrobat Sign".

Once you complete and sign the document, the form will be sent to Human Resources for eligibility review and processing. You will be given an option to download your completed form.

If you don't see the form in your inbox within 10 minutes of submitting this form, please check your spam/junk folders. If you still do not see the form, please contact the Benefits office benefits@cambridgema.gov or call 617-349-1770.
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Teamsters Long-Term Disability