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MESA Medical & Benefits Plan 1007 Eastern Avenue Baltimore, MD 212024345 4105479111 * 800811MEBA (6322) * 4105476665 (Fax) * www.mebaplans.org PERMANENT DATA FORM COMPLETE BOTH PAGES OF THIS FORM,
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Gather all required documents, such as medical records, prescriptions, and disability certificates.
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MEBA Medical & Benefits (MEBA) is a program that provides medical benefits to eligible MEBA members.
MEBA members who are eligible for medical benefits are required to file MEBA Medical & Benefits.
MEBA members can fill out MEBA Medical & Benefits forms either online or by submitting paper forms to the MEBA office.
The purpose of MEBA Medical & Benefits is to provide medical coverage to eligible MEBA members and their dependents.
MEBA members must report their personal information, dependent information, and any changes to their medical status on MEBA Medical & Benefits forms.
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