Online Enrollment

Online Enrollment Policy
(Adopted via Resolution No. 003-2018)

Required Documents:  Municipal Determination of Subscriber Online Enrollment Commitment

Instructions for Enrollment Additions/Deletions/Changes:
Submit SF FAP form (from link below) and Dependent Eligibility Verification Form:

  • By secure web portal (Benefit Clerks should contact the Consortium's Administrative Clerk for log-in instructions); or
  • by fax: 607-274-5505; or
  • by US Mail (an additional time lag built into this process) to the Greater Tompkins County Municipal Health Insurance Consortium, Attn: ­­­­­­­­­­­­­­­­­Enrollment, 125 East Court Street, Ithaca, New York 14850

Once the enrollment application is received by the Consortium, the enrollment data will be submitted online within three (3) business days.  Confirmation of enrollment will be confirmed by the Consortium within 3 days of entering the change in the Excellus enrollment software. Should Excellus software not accept the enrollment submission, notice of incomplete information will be sent to the municipal partner within three (3) business days. 

Enrollment delegated to Consortium: 
(Forms linked to municipality)
Municipalities responsible for enrollment: 
Town of Aurelius Seneca County 
Town of Caroline Tompkins County
Town of Cincinnatus City of Cortland
Town of Danby City of Ithaca
Town of Enfield Town of Big Flats
Town of Homer Town of Dryden
Town of Marathon Town of Groton
Town of Mentz Town of Ithaca
Town of Montezuma Town of Lansing
Town of Moravia Town of Ulysses
Town of Newfield  Village of Cayuga Heights
Town of Niles ViIllage of Groton
Town of Owasco Village of  Trumansburg
Town of Preble  
Town of Scipio   
Town of Sennett  
Town of Springport   
Town of Truxton  
Town of Virgil  
Town of Willet  
Village of Dryden  
Village of Freeville  
Village of Homer  
Village of Horseheads  
Village of Lansing  
Village of Union Springs