TELEMEDICINE BENEFIT PROGRAM ENROLLMENT

Step 1
Complete the TeleMedicine Census Form. List all employees and indicate whether they are participating.

Step 2
Each participating employee completes the Group TeleMedicine Application.

Step 3
Complete the TeleMedicine Agreement for List Billing.

Step 4
Return all completed documents to:
The TDA Insurance Agency
6505 Lee Highway
Chattanooga, TN 37421

Fax: 866.791.2806
Email: TDA@assoc-admin.com