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American Medical Access Plan (AMA Plan) for Individuals Forms
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| Click on the form name for a printable PDF version. |
| • Member Application |
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| • Claim Form |
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| • AMA-Gold Membership App with Payment Auth. |
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| • AMA-Silver Membership App with Payment Auth. |
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American Benefit Administrative Services, Inc. / Third Party Administrators, Inc. |
1733 Park Street, Suite 300
Naperville, Illinois 60563
630-416-1111 • 800-736-7872 • Fax: 630-416-9310
© 2012 American Benefit Administrative Services, Inc. / Third Party Administrators, Inc.
Naperville, Illinois 60563
630-416-1111 • 800-736-7872 • Fax: 630-416-9310
© 2012 American Benefit Administrative Services, Inc. / Third Party Administrators, Inc.