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At Mountain States we are on a Mission:

"To satisfy our clients needs and expectations through the development of quality plans, while delivering exceptional customer service by exceptional employees."
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Find a Doctor
Click here to find a listing of PPO Network websites.

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MSAS Medical Forms

Please click on the form type below to view.

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  • Accident Letter*
  • Dental Claim Form
  • HRA Claim Form
  • Medical Claim Form (HCFA 1500)
  • MSAS Patient Information Form
  • Other Insurance Coverage Letter*
  • Subrogation Letter*
  • Vision Claim Form

    Click here to download Adobe Acrobat Reader

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    Pharmacy Websites
    Click here to find a listing of Pharmacy websites.

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    Flexible Spending Accounts

    Please click on the form type below to view.

  • FSA Claim Form
  • FSA Expense Estimation Worksheet
  • FSA Eligible OTC List
  • Letter of Medical Necessity
  • FSA Receipt For Independent Day Care Provider

    Click here to download Adobe Acrobat Reader

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    MyMSAS online may allow clients to view:
  • Claims Information
  • Coverage Verification
  • Flexible Spending Account Balances

    • MyMSAS Online Registration Instructions

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