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

MBA Forms

• Dental Claim Form
• Change Of Address

• Flexible Spending Election/Change Form Form
• Dependent Care Enrollment Form
• Continual Reimbursement Request Form
• Medical Expense Reimbursement Voucher
• FSA Eligible Expenses
• Change Of Address

• Accident Claim
• Health Enrollment Form
• Medical Claim Form
• Change Of Address
• Subrogation Agreement

• Health Reimbursement Claim Form
• Change Of Address

• Magellan Rx Pharmacy – Mail Order Form
• Magellan Rx Reimbursement Form

• Vision Claim Form
• Change Of Address

• Health Fair Claim Form
• MBA Steps – Walking Log