Need a claim form? Employer or employee application? Change request form? This page allows you to download our most frequently used forms as well as our most recent prescription formularies.

Get Acrobat ReaderAll forms are saved in the .PDF format. To view and print a form requires Adobe Acrobat Reader. You can download a free copy of Reader by clicking here.

If you have any questions about what forms your group uses, contact the MedBen Customer Service Department at 800-686-8425 or medben@medben.com. Questions regarding MedBen VisionPlus forms may be addressed to MedBen VisionPlus Customer Service at 800-252-3447 or visionplus@medben.com. For technical questions relating to downloading and printing of forms, e-mail this site's webmaster at chuckj@medben.com.

For MedBen Mutual (fully-insured product) forms and prescription formularies:

  • For Indiana-based groups, click here.

  • For Michigan-based groups, click here.

  • For Ohio-based groups, click here.

  • For West Virginia-based groups, click here.

For MedBen Administrators (self-funded product) forms and prescription formularies, click here.

For MedBen Specialty Services forms, including COBRA,  HIPAA, flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs), click here.

For MedBen Dental and VisionPlus (group vision benefits) forms, click here.