This is a request form for any type of medical records that need to be requested for newborns through two months of age.
DownloadThis is a request form for any type of medical records that need to be requested for children 3-25 months old.
DownloadThis is a request form for any type of medical records that need to be requested for adults aged 40 or older.
DownloadMost providers will file health care claims for you. However, should you need to file a claim, please complete this form.
DownloadTo file prescription drug claims for out of network pharmacies, complete this form and attach your prescription receipt or a print-out of your prescriptions signed by your pharmacist. All In-Network claims will be filed electronically.
DownloadThis document outlines the schedule of benefits for the Advanced Choice Health Plan.
DownloadThis document outlines the schedule of benefits for the Classic Choice Health Plan.
DownloadThis form is for you to complete when submitting a request for reconsideration of a benefit exclusion rider that has been placed on you or any dependents. Please use one form per rider being reviewed.
DownloadThis form is for you to complete when submitting a request for reconsideration of declined coverage for you or any dependents.
DownloadThis form is for you to complete when submitting a request for reconsideration of your rate for coverage.
DownloadThis form is for you to complete when submitting a request for reconsideration of tobacco rate for coverage.
DownloadThis form allows an employer to let MOFB Health Plans know an employee/client of a Missouri Farm Bureau Plan no longer works for them and the client will take over the health plan payment.
DownloadPlease complete this form if cancelling your coverage with Missouri Farm Bureau Health Plans.
DownloadThis resource explains the grievance procedure used by Missouri Farm Bureau Health Plans. If you would like to file a grievance, please use this form.
DownloadUse this form if you would like to file a grievance, after you've read the grievance procedure.
DownloadYour completion of this form allows you to designate someone as your personal representative on your Missouri Farm Bureau Health Plans coverage.
DownloadIf you need to change your bank information for your monthly premium payment and you are under the age of 65, complete this form, attach a voided check and mail both to Missouri Farm Bureau Health Plans.
DownloadThis form allows you to make changes to your current coverage if you are under 65. The form has the functionality for a digital signature, but it must be opened in Acrobat (not the web browser) for it to work correctly.
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