Blue Cross/Blue Shield International Claim Form
Blue Cross/Blue Shield Medical Claim Form
MEBA Diagnostic Center Transportation Reimbursement Claim Form
MEBA Medical Plan Address Change Form
MEBA Medical Plan Application for Reimbursement of Pensioner Medical Contributions
MEBA Medical Plan Authorization for the Use and Disclosure of PHI
MEBA Medical Plan Beneficiary Designation Form
MEBA Medical Plan Statement of Claims for Members and Dependents
MEBA Medical Plan Complaint Form
MEBA Medical Plan Confidential Communications Request
MEBA Medical Plan Dependent Parent Supporting Statement
MEBA Medical Plan Designation of Authorized Representative for Claims and Appeals
MEBA Medical Plan Designation of Health Information Recipient Form
MEBA Medical Plan Incident/Accident Report Form
MEBA Medical Plan Medicare Part B Reimbursement Application
MEBA Medical Plan Restriction Request
MEBA Medical Plan Request for Amendment of PHI
MEBA Medical Plan Request for Disclosures of PHI
MEBA Medical Plan Request for Inspection of PHI
MEBA Medical Plan Permanent Data Form
MEBA Medical Plan Short-Term Disability Claim Form for Members
MEBA Medical Plan Spouse Medical Coverage Waiver Form
MEBA Medical Plan Student Status Form
MEBA Medical Plan Subrogation Reimbursement Agreement
MEBA Medical Plan Travel Profile
OptumRx Direct Member Reimbursement Form
Amendment 23-4 MEBA Medical Plan
Amendment 23-3 MEBA Medical Plan
Amendment 23-2 MEBA Medical Plan
Amendment 23-1 MEBA Medical Plan
Amendment 22-5 MEBA Medical Plan
Amendment 22-4 MEBA Medical Plan
Amendment 22-3 MEBA Medical Plan
Amendment 22-2 MEBA Pension Plan
Amendment 22-1 MEBA Medical Plan
Amendment 21-6 MEBA Medical Plan
Amendment 21-5 MEBA Medical Plan
Amendment 21-3 MEBA Medical Plan
Amendment 21-2 MEBA Medical Plan
Amendment 21-1 MEBA Medical Plan
Amendment 20-8 MEBA Medical Plan
Amendment 20-7 MEBA Medical Plan
Amendment 20-6 MEBA Medical Plan
Amendment 20-5 MEBA Medical Plan
Amendment 20-4 MEBA Medical Plan
Amendment 20-3 MEBA Medical Plan
Amendment 20-2 MEBA Medical Plan
Amendment 20-1 MEBA Medical Plan
Amendment 19-2 MEBA Medical Plan
Amendment 19-1 MEBA Medical Plan
Amendment 18-5 MEBA Medical Plan
Amendment 18-4 MEBA Medical Plan
Amendment 18-3 MEBA Medical Plan
Amendment 18-2 MEBA Medical Plan
Amendment 18-1 MEBA Medical Plan
Amendment 17-8 MEBA Medical Plan
Amendment 17-7 MEBA Medical Plan
Amendment 17-6 MEBA Medical Plan
Amendment 17-5 MEBA Medical Plan
Amendment 17-4 MEBA Medical Plan
Amendment 17-3 MEBA Medical Plan
Amendment 17-2 MEBA Medical Plan
Amendment 17-1 MEBA Medical Plan
Amendment 16-9 MEBA Medical Plan
Amendment 16-8 MEBA Medical Plan
Amendment 16-7 MEBA Medical Plan
Amendment 16-6 MEBA Medical Plan
Amendment 16-5 MEBA Medical Plan
Amendment 16-4 MEBA Medical Plan
Amendment 16-3 MEBA Medical Plan
MEBA Medical Plan Diagnostic Centers (April 2024 SMM)
MEBA Medical Plan COVID-19 and Retiree Dental (August 2023 SMM)
MEBA Medical Plan MITAGS eligibility (October 2021 SMM)
MEBA Medical Plan Multiple Changed (March 2021 SMM)
MEBA Medical Plan Multiple Changes (JULY 2020 SMM)
MEBA Medical Plan - Bariatric (March 2020 SMM)
MEBA Medical Plan - Delta Dental Plan Design Changes (DECEMBER 2019 SMM)
MEBA Medical Plan Chiropractic Treatment And Physical Therapy (MARCH 2019 SMM)
MEBA Medical Plan OOP Limit and Uncashed Checks - (December 2018 SMM)
MEBA Medical Plan Reasonable Customary - Allowable (August 2018 SMM)
MEBA Medical Plan Summary of Benefits Coverage (Active Participants)
MEBA Medical Plan Summary of Benefits Coverage (Retirees 15-19 Years)
MEBA Medical Plan Summary of Benefits Coverage (Non-Medicare-Eligible Retirees 20 Years+)
MEBA Medical Plan Summary of Benefits Coverage (Medicare-Eligible Retirees 20 Years+ )
MEBA Medical Plan Alternate Gulf Clinic Notice 2011
MEBA Medical Plan American Health Holding Notice to Participants
MEBA Medical Plan Annual CHIPRA Notice
MEBA Medical Plan Drug Testing Notice
MEBA Medical Plan EERP Notice to Plan Participants
MEBA Medical Plan Exchange Marketplace Notice
MEBA Medical Plan Grievance Procedure
MEBA Medical Plan HIPAA Privacy Notice
MEBA Medical Plan Annual WHCRA Notice
OptumRx re Spring 2019 prescription drug changes
OptumRx Formulary Updates July 2024
OptumRx Standard Formulary Booklet July 2024
MEBA DEEP SEA Retiree Information Form
MEBA STAFF Retiree Information Form
MEBA TOWBOAT Retireee InformatIon Form
MEBA Authorization for Direct Debit of Pensioner Medical Contributions
MEBA Declaration of Retirement from the Maritime Industry
MEBA Designation of Authorized Representative for Claims and Appeals
MEBA Disability Pension Application Packet
MEBA Pension Application Packet
MEBA Pension Benefit Direct Deposit Authorization
MEBA Pensioner Employment Rights
MEBA Pensioner Reemployment Application (Government Vessel Port Engineer)
MEBA Pensioner Reemployment Application (Night Relief)
MEBA Pensioner Reemployment Application (Vessel)
MEBA Retirement Options Descriptions
MEBA Retirement Survivor Option Election Form