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Employee Benefit Management Services, Inc - EBMS

"EBMS is known within the marketplace for consistent, personable service that works."

---Liz, Vice President, Stop-loss carrier

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Downloadable Forms and Information
    Automatic Orthodontia Flex Reimbursement
   Auto Flex Election Form (PDF)  

    EBMS Accident Letter (PDF)

    EBMS Claim Form (PDF)
    EBMS Provider Authorization (PDF) 
    Enrollment Form (Printable)
    FLEX Brochure (PDF)
    FLEX Direct Deposit Authorization Form (PDF)
    FLEX Eiligible Expense Reference List (PDF)
   FLEX Enrollment Form (Downloadable) 
    FLEX Reimbursement Form (Downloadable)
    FLEX Reimbursement Form Including Parking/Transportation (Downloadable)
    Request For HRA Reimbursement (PDF)

    Cobra Brochure (PDF) 
    Cobra Brochure- Spanish (PDF) 
    Wyoming Miners Benefit Registration Form (PDF) 
    Wyoming Miners Health & Rx Assisst Form (PDF)
    Wyoming Miners Hearing Aid Form (PDF)
    Wyoming Miners Hearing Aid Assist Form (PDF)
 

 
 

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