Get Hba Form

Filling out the Hba Form online is a straightforward process that allows you to provide essential information for updating your Health Benefit Administrator details. This guide will walk you through each section of the form to ensure you complete it accurately and efficiently.

Follow the steps to complete the Hba Form online with ease.

1. Click ‘Get Form’ button to access the form and open it in your browser.
2. Begin by entering your group's name in the 'Group Name' field and write down the 'Group Number' to identify your organization.
3. In the 'Health Benefit Administrator Information' section, fill in the HBA's name, address, city, state, zip code, telephone number, and email address only if you want MVP to update this information.
4. Proceed to the 'Group Designee Information' section if you need to add or remove employees authorized to receive enrollment and eligibility information. Indicate the plan sponsor’s name and designate the employees by filling in their name, title, telephone number, and email address.
5. For each additional designee, use the 'Add/Delete' format to specify if they are being added or removed, providing the required contact details.
6. At the bottom of the form, ensure to have the 'Corporate Officer Signature,' along with their title and the date of signing, to validate the submission.
7. Once all information is completed, save your changes. You can also download, print, or share the completed form as needed.

Begin filling out your Hba Form online now to ensure accurate contact information.