Medicare Direct Deposit

Medicare Direct Deposit

Please answer the questions below so that we can send the Medicare direct deposit document to the email address you provide on this form.
First Name
Last Name
Email
Please use your City email address if you have one. example@example.com
Please verify that you are human
Next Steps

After you click the Submit button below, we will send the Medicare direct deposit 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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