Request Information

MHBP members: Select "MHBP Member" and complete the form to request 2014 health plan information.  

Non-members: Complete the form to receive 2014 benefits information.  Thanks for your interest in MHBP.

You may only request one item per transaction. You may request more by repeating the process.  Use the special link on the Thank You page to request another item and your information will be prepopulated.


  (* Required information)

I am a: MHBP Member Non-Member
Country of Residence:
First Name*
Last Name*
Address*
Apartment, Suite, or Lot number (if appropriate)
City*
State*
State/Region/Province*
ZIP Code*
Postal Code*
Email Address
Confirm Email Address
Phone Number
( ) -


Please send me:

  MHBP Plans and Programs Overview
  Official Plan Brochure
  Summary of Benefits & Coverage
I give MHBP permission to communicate with me using the information that I have provided. I understand that MHBP will not share or sell my information, rather MHBP will use it to keep me informed about its programs and services.

  Yes
  No
 
 

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