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Human Resources Department

 
 

 

 
 
Employee Benefits Information

 

Benefits Contact Information Sheet  
     
Return to the Human Resources Department webpage  
     
 
 
This page contains contact information and forms related to Employee Benefits.
Click one of these links to jump to the Benefits Section on this page:
Dental Division Retirement Plan   Flexible Spending Plans Health Insurance
  Vision   Voluntary Benefits  
         
 Dental    MedBen Group #10398   
Claims Service:  Medben
Website:  www.medben.com  
Phone Number:

 800-686-8425

 
Address:  MedBen P.O Box 1099 Newark, OH 43058-1099
   
Dental Providers:  Employees may go to any dentist.
 
Dental Insurance Forms and Information:
  Dental Summary of Benefits
  Dental Claim Form
 Health, Dental, and Vision Premiums
 
 
 Division Retirement Plan   
 
 
 
     
 
 Flexible Spending Plans  
Company:  MedBen Specialty Services Unit  
Address:  1975 Tamarack Rd., P.O. Box 1096  
   Newark, OH 43058-1096  
Customer Service Number:  800-297-1829 or 740-522-8425  
Customer Service Hours:  Mon. - Fri., 9:00AM - 7:30PM CST  
Fax Number:  740-522-7483  
E-mail Address:  admin@medben.com  
Website:  www.medben.com  
     

Flexible Spending Account Forms and Information:

 
 ● MCCH Flexible Benefit Plan  
  Debit Card Substantiation Form - Submittal of Receipts  
  Dependent Care Receipt for Services Form  
  Dependent Care Spending Reimbursement Request Form  
  FAQ - Flexible Spending Account Benny Card  
  FAQ - How does Health Care Reform affect your Health FSA Plan  
  Health Care Spending Reimbursement Request Form  
  Health FSA - Orthodontia Services Reimbursement Form  
  MedBen Basics FSA Online System  
  Request for Debit Card  
     
 
     
 
 Health Insurance    MedBen Group #10398  
Claims Service:  MedBen  
Website:  www.medben.com  
Phone Number:  800-686-8425  
Address:  MedBen P.O. Box 1099 Newark, OH 43058-1099  
     
Pharmacy Help Desk:  (800) 549-0097  
Utilization and Pre-certification  iProcert:  (866) 214-5962  
Pharmacy Website: www.pdmi.com  
Current Pharmacy Formulary is on the MedBen website.  
 1. Log in on the MedBen website https://mbaccess.medben.com/  
 2. Put your cursor on 'Requests'  
 3. Click on 'Downloadable Forms'  
 4. Click on '2011 Outcomes Formulary'  
 MCCH Over-The-Counter Drug Benefit information  
   
   
Health Insurance Forms and Information:  
 MCCH Medical Plan  added 10-2011  
  Family Status Change Form  
  Murray Non-Domestic Referral Request  
 Domestic COPAY Physician Listing  
 Domestic TIER Physicians Listing  
 MedBen Plan A  
 MedBen Plan B  
 Health, Dental, and Vision Premiums  
Bluegrass Network Website:  http://www.bgfh.com/provider.asp  
Bluegrass Provider Participation inquiry:  http://www.bgfhtpa.com  
   
   
 Vision    VSP  Group #30022580  
Vision Benefit Questions:  1-800-877-7195  
     

For a list of VSP Providers, visit this website:  www.vsp.com

 
     
Vision Insurance Forms and Information:  
 Vision Plan  
 Health, Dental, and Vision Premiums  
   
VSP does not sent out ID Cards.  
You can visit www.vsp.com, setup an account, and print out an ID card.  
   
Using your VSP Insurance with Walmart Services, or other non-VSP providers.  
    Walmart is not on the list of VSP Providers.  
    For reimbursement from Walmart Vision services, follow these steps:  
 1. Pay the initial full amount at Walmart when you get service.  
 2. When you pay, ask for an itemized receipt.  
 3. Use that receipt and complete the VSP Reimbursement Claim Form.  
 4. Send the completed reimbursement form to VSP.  
  More detailed instructions about using non-VSP providers  
   
Visit the VSP website and click Register Now, for a complete provider listing.  
   
  Comparison of covered services and open-access.  
The Walmart rates listed in the comparison will vary by location.  
   
 Voluntary Benefits Information  
 ● Accident - Colonial  
 Basic Life and Accidental Death and Dismemberment  
 Benefits Counselor Yearly Schedule  
  Group Cancer 1000 Level 2 Brochure  
  Group Cancer 1000 Level 2 Outline  
 Long Term Disability Overview  
 Medical Bridge Coverage  
 Short Term Disability Overview  
 Supplemental Life - Companion  
 Term Life - Colonial  
   
   
   
 
 

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