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Why Be Self-Funded?

Self-funding your employer health plan offers a greater level of control and savings than fully-insured coverage. Self-funded employers have greater control about their plan’s benefits and ancillary services, medical and pharmacy networks, and member contributions. Best of all, you pay only for actual member claims received, rather than pooling premiums with employers who may have less healthy populations.


You keep any money that doesn’t go toward paying claims… and MedBen helps you keep as much of that money as possible.



You choose the health care plan options that work best for your employees.



Self-funding offers a greater degree of freedom from state and federal regulations.

If you’re fully insured, MedBen can assist you in making the switch to self-funding. And if you already have a self-funded plan in place, you’ll find that we offer outstanding service and benefit management tools.

Dedicated to helping your plan succeed.

If you’re a current MedBen client, we are pleased to serve your business and help you succeed… and if you’re not, we’d welcome the opportunity to work with you.

Here you’ll find links to useful plan administration resources. Should you need further assistance, please contact your dedicated Account Representative team.

And thanks again for choosing MedBen!


Use this secure 24/7 service portal to access claims and benefits information. If you need assistance logging in or using the site, please contact your team of dedicated Account Representatives.


MedBen Access is also available as a mobile app! Download it from the Apple App Store or Google Play (search for “MedBen”).

Track your plan performance using our interactive executive dashboard. To set up your account, please contact your Account Management team.

PLEASE NOTE: The reporting platform will not work in the Internet Explorer browser. Please use Firefox or Google Chrome for best results.

Documents containing protected health information (PHI) are posted electronically on this safeguarded site. When a document is available, you will automatically receive an e-mail notification with download instructions.

FSA Store and HSA Store simplify shopping for FSA- and HSA-eligible products. When you use your MedBen debit card at the FSA Store, you don’t need to substantiate your purchase!

FSA and HSA Stores remove the guesswork from determining if your purchase is qualified for reimbursement, and offer a 100% product eligibility guarantee.

FSA/HRA/HSA IRS-Eligible Expenses

MedBen offers two detailed lists of qualified medical expenses under Section 213 of the Internal Revenue Code.

The MedBen Health Care Expenses Table offers detailed information about FSA-, HRA-, and HSA-eligible products and service types, as well as those that may be potentially eligible depending on circumstances.

When the opening screen appears, simply type in the MedBen password HCET2022 (case sensitive) and press the “Enter” button on your keyboard.

The FSA Store and HSA Store Eligibility Lists are a convenient way to check eligibility AND shop for specific items.

To see HRA Expenses, under either Eligibility List, select “Health Reimbursement Account (HRA)” from the Account drop-down box.

Search for participating pharmacies, discount stores and supermarkets that can offer FSA-eligible items.

Most stores use an Inventory Information Approval System (IIAS) which identifies eligible items at checkout – you will not need to provide a receipt from these stores in most cases.

“90% stores” do not use IIAS, but 90% of their sales come from medical care items, thus making them FSA-eligible. You will need to provide a receipt from these stores.


Medical and Pharmacy

Prescription Prior Authorization Request Form – Use for all pharmacy benefits managers except Ventegra (check your ID card to find your PBM).

Prescription Prior Authorization Request Form – Use for Ventegra only (check your ID card to find your PBM).

Covid Home Test Paper Claim Form (Ventegra) – Use this form to request reimbursement from Ventegra when you have purchased a Covid Home Test Kit at retail cost (check your ID card to find your PBM).


Dental Employee Application – Apply or make coverage changes.

Dental AND Vision Employee Application  Apply for dental and/or vision coverage or make coverage changes.


Vision Employee Application – Apply or make coverage changes.

Vision AND Dental Employee Application  Apply for dental and/or vision coverage or make coverage changes.


Employee’s Guide to Flexible Spending Accounts (with Debit Card) – Overview/FAQ of MedBen FSAs for plan participants who use MedBen debit cards.

Employee’s Guide to Flexible Spending Accounts (No Debit Card) – Overview/FAQ of MedBen FSAs for plan participants who don’t use MedBen debit cards.

FSA Mileage Reimbursement Form – For claiming under your Health FSA the mileage used to obtain qualified medical services from a physician, hospital or facility to prevent or alleviate a physical disease, defect or illness.

Debit Card Substantiation Form – Substantiate purchases made with your MedBen Debit Card.

Orthodontia Services Reimbursement Request Form – An orthodontist (or authorized bookkeeper) can use this form to request reimbursement for services.

Request for Debit Card – Request a debit card for your dependent or replace a lost or stolen card.

Health Care FSA Examples of Qualified Medical Expenses – Examples of services and medical products that can be purchased with FSA funds.

Limited Purpose Health Care FSA Examples of Qualified Medical Expenses – Examples of dental and vision services and products that can be purchased with limited purpose FSA funds.

Sample Letter of Medical Necessity  If a Letter of Medical Necessity is required from your provider to receive reimbursement from your FSA, this sample letter can be used for that purpose. Simply print out/save and give to your doctor.

FSA Reimbursement Request Form – Used when requesting reimbursement from a Health FSA plan, Limited Purpose FSA plan and/or Dependent Care reimbursement plan.


HRA Reimbursement Request Form – Request reimbursement from your HRA account. NOTE: This form is generic and may not be specifically based on your HRA plan design.


COBRA Qualifying Event Form – Notifies MedBen of a COBRA qualifying event.


Access to Personal Information Request Form – Request access to copy or inspect personal health information held by MedBen.

Request to Restrict Uses and Disclosures of Protected Health Information – Request restrictions of the use or disclosure of personal health information held by MedBen.

Request for Personal Identification Number – Request MedBen to provide a Personal Identification Number (PID) for a plan member.

PHI Disclosure Accounting Request Form – Request an accounting of disclosures made by MedBen of your health and medical information.

Confidential Communication Request Form – Request alternate means of communication with MedBen.

PHI Amendment Request Form – Request MedBen to make corrections or amendments to your protected health information.

Notification and Authorization of Personal Representative Form – Designate an individual as your personal representative for purposes of coverage under selected health plan(s).

Authorization Form for Uses and Disclosures of Insured Information – Authorize the use or disclosure of your individually identifiable and/or personal health information.

Privacy Complaint FormRegister a complaint if you believe anyone at MedBen has inappropriately used or disclosed protected health information.


Disability Claim Form – Plan members can submit a claim for long-term or short-term disability benefits.

Transportation Reimbursement Form – Plan members can request reimbursement from their transportation compensation account.

Notice of Appeal/Designation of Authorization Form – Plan members wishing to file a formal appeal of a disputed claim should use this form. They can also designate another entity to file an appeal on their behalf. (Please print and sign form before sending.)

Death Claim Form (Life Insurance Claim) – Please contact MedBen Customer Service (800-686-8425 or medben@medben.com) to obtain a death claim form. Employers must complete and return this form (accompanied by a certified copy of the death certificate) in order for designated beneficiary to receive life insurance benefits.


blue and white pills spilling from bottleMedBen clients who use Ventegra or Pharmacy Data Management, Inc. (PDMI) as their Rx network for their pharmacy plan can request the most recent formulary from their Account Representative.

MedBen clients who use pharmacy networks other than Ventegra or PDMI can typically access formulary information through that network’s website. Visit the Networks page for pharmacy network links.


Visit the Networks page for links to medical, pharmacy, vision and dental networks.

Tell Your Broker!

Like what MedBen has to offer and want to let your broker know? We’ll help you take the first step.

Just click on the link below… it’ll create an e-mail for your broker, complete with message. Just replace the “TO” email address with your broker’s, plug in your names, and you’re good to go!

Self-funding Saves. MedBen Delivers.