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Contact for Service

Group Benefit Services, Inc.
6 North Park Drive, Suite 310
Hunt Valley, MD 21030
Phone: 800.638.6085
Email: sales@gbsio.net

Please tell us who you are: *

Broker

Employer

Member

BROKER

Name *

Agency Name *

Email Address *

Daytime Phone Number *

Product *

Self Funded

Engagement Rewards Program

Fully Insured

Voluntary Benefits

GBSAccess

Purpose *

Marketing Materials

Sales

Quote Request

More Information

Commissions

Username/Password

Message

EMPLOYER

Please check which type of employee benefit plan you are requesting service for: *

Fully-Insured (CareFirst, Aetna, United Healthcare, Kaiser, Cigna)

Self-Funded

Non Group Health Insurance

Group Name *

Group # *

Contact Name *

Email Address *

Daytime Phone Number *

MEMBER

Request Type

Forms (HRA Claims Form, FSA Claims Form, Self-Funded Claims Form, Evidence of Insurability)

Add or Delete a Dependent (Enrollment Form)

Change Address (enter new address below)

Send additional ID Card - MEDICAL

Send additional ID Card - HRA

Send additional ID Card - FSA

Request username and password for GBSAccess (Broker/Employer)

Street

City

State

Zip

Question Regarding:

Benefits

Eligibility

COBRA

HRA or FSA

Claims Status (enter details below)

Provider Name

Date of Service

Additional information regarding my request:

Name

Member ID# (as displayed on your ID Card) *

Employer Name

Email Address *

Daytime Phone Number *

Request Type:

Forms (HRA Claims Form, FSA Claims Form, Self-Funded Claims Form, Evidence of Insurability)

Add or Delete a Dependent (Enrollment Form)

Change Address (enter new address below)

Send additional ID Card - MEDICAL

Send additional ID Card - HRA

Send additional ID Card - FSA

Street

City

State

Zip

Question Regarding:

Benefits

Eligibility

COBRA

HRA or FSA

Claims Status (enter details below)

Provider Name

Date of Service

Additional information regarding my request:

Leave this field blank

6 North Park Drive, Suite 310
Hunt Valley, MD 21030
Phone: 800.638.6085
Email: sales@gbsio.net

BROKER

EMPLOYER

MEMBER

6 North Park Drive, Suite 310 Hunt Valley, MD 21030 Phone: 800.638.6085 Email: sales@gbsio.net

6 North Park Drive, Suite 310
Hunt Valley, MD 21030
Phone: 800.638.6085
Email: sales@gbsio.net