Loft Benefits Premium Enrollment

Please fill out the form below to enroll in the 2024 Loft Benefits program. Only one submission per household is needed. The same benefit cannot be selected more than once. If you have a joint account, please fill in both account owners names and emails.

Full Benefit List and Instructions

Loft Benefits 2024 Enrollment Form

Please select one benefit from the dropdown box.
Benefit selected must be different from choice 1.
Benefit selected must be different from choices 1 & 2.
Please enter your unique client code.

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