MBA Resources & Forms
Contact MBA
Toll Free: 1-800-877-3727
Fax: 1-801-747-5205
Email: claims@mbaadministrators.com
- Prescription Drugs, Magellan Rx, Pharmacy Help Desk: 800-424-0472
- Employee Assistance Program (EAP), Blomquist Hale Consulting, 1-800-926-9619
- Teladoc: 1-800-Teladoc (835-2362)
- Claims and Eligibility, Login
- Ameritas: 1-888-336-7601
- Download MBA Member App
Contact your HR Dept. about access to our employee benefits portal!
MBA Forms
Dental
Flexible Spending
- Flexible Spending Election/Change Form Form
- Dependent Care Enrollment Form
- Continual Reimbursement Request Form
- Medical Expense Reimbursement Voucher
- FSA Eligible Expenses
- Change Of Address
Health
- Pre-Authorization Information Form
- Accident Claim
- Health Enrollment Form
- Medical Claim Form
- Change Of Address
- Subrogation Agreement
HRA
RX
- Magellan Rx Pharmacy - Mail Order Form
- Magellan Rx Reimbursement Form
- GoodRx Credit Form
- ProAct DMR Form
- ProAct DMR Form - Español
Vision
Wellness
- Health Fair Claim Form
- MBA Steps - Walking Log
