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MEBA Medical & Benefits Plan 1007 Eastern Avenue Baltimore, MD 212024345 4105479111 * 800811MEBA (TollFree) * 4106591675 (Fax) * www.mebaplans.org Statement of Claim for Members and Dependents.

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How to fill out the Meba Plans online

Filling out the Meba Plans online can seem daunting, but with this comprehensive guide, you will understand each step of the process. This guide will walk you through the necessary sections of the form to help ensure you submit a complete and accurate claim.

Follow the steps to successfully complete the Meba Plans online

  1. Click ‘Get Form’ button to obtain the form and open it in your editing interface.
  2. Begin by filling out the member information section. Input the member's name, marital status, mailing address, and telephone number. If you have a new address, be sure to check the corresponding box.
  3. Provide the member's ID number, date of birth, last employment details, and status options, such as sailing, pensioner, or other relevant categories.
  4. Complete the patient information section if the claim is for dependents, retirees or COBRA enrollees. Fill in the patient's name, relationship to the member, date of birth, and gender.
  5. Indicate whether the patient is employed and if they possess other coverage. If applicable, provide necessary information regarding other insurance plans, including the policyholder name and coverage specifics.
  6. If the patient is eligible for Medicare, fill in the corresponding sections with the effective dates of Medicare Part A and Part B.
  7. In the signature section, the member, spouse, or responsible guardian must sign and date the form to certify that all provided information is true and complete.
  8. Finally, complete any required sections regarding optical, orthodontia, or hearing aid benefits by providing necessary diagnosis codes and service charges as applicable. Ensure that the service provider completes their section and that all itemized bills are attached.
  9. Once the form is fully completed, review your entries for accuracy. Save any changes, and you may also download, print, or share the form as necessary.

Complete your Meba Plans online today to ensure timely processing of your claims!

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