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Click ‘Get Form’ to open the messa ppo referral form in the editor.
Begin by entering the 'Date of Referral' in the designated fields, ensuring you include the month, day, and year.
Fill in the 'Subscriber Name' and 'Member's Last Name', followed by their 'First Name' and 'Date of Birth'.
Provide details for the 'Non-PPO/Practitioner/Facility/Lab Name', including their address, city, state, zip code, and telephone number.
Complete the section for the 'Referring PPO/Practitioner/Facility/Lab Name' with similar details as above.
Specify the 'Reason For Referral', along with anticipated service dates and treatment length.
Ensure all required signatures are obtained at the bottom of the form for validity before submission.

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Versions	Form popularity	Fillable & printable
2023	4.2 Satisfied (49 Votes)
2022	4.8 Satisfied (55 Votes)
2020	4.8 Satisfied (247 Votes)
2020	4.8 Satisfied (117 Votes)
2020	4.8 Satisfied (101 Votes)
2020	4.7 Satisfied (51 Votes)
2020	4.3 Satisfied (26 Votes)
2020	4.8 Satisfied (261 Votes)
2020	4.2 Satisfied (36 Votes)
2020	4.4 Satisfied (134 Votes)
2019	4.5 Satisfied (54 Votes)
2019	4.8 Satisfied (130 Votes)
2019	4.8 Satisfied (171 Votes)
2019	4.8 Satisfied (35 Votes)
2019	4.8 Satisfied (142 Votes)

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What are MESSA essentials?

Your Essentials by MESSA plan includes a list of preventive drugs that are covered at no charge no deductible, no copayment and no coinsurance. This helps you stretch your health care dollars and limit your out-of-pocket costs. View the list. Up to 34-day supply. 90-day supply.

What insurance completely covers therapy?

What insurance covers mental health therapy? All individual and family ACA plans sold through the Health Insurance Marketplace and directly from insurers cover mental health benefits, including therapy.

Does MESSA cover therapy?

Therapy is available for members 13 and older. Psychiatry is available for members 18 and older. To get started, visit messa.org/Teladoc or download the Teladoc Health mobile app and enter your MESSA plan information. Just like traditional office visits, your copayment, deductible and/or coinsurance applies.

When did MESSA form?

MESSA was born out of need at a time when public school employees had few health care options. In 1937, the Michigan Education Association started the first group hospitalization program for public school employees.

What is MyMESSA?

Your MyMESSA member account is a one-stop shop for all of your MESSA benefits. If youre a new member, its easy to set up your account. Go to messa.org, select MyMESSA Login and follow the instructions. Adult dependents can also set up MyMESSA accounts for themselves.