Advantra Savings (MSA)
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Advantra Savings (MSA) Member Forms
Provider Outreach Form
Complete this form if you would like an Advantra Savings (MSA) representative to contact your physician(s) on your behalf to explain how the plan works and to answer any questions your doctor's office may have.
Member Letter to Provider
This letter will provide your physician with important information about your Advantra Savings (MSA) health plan and guide her or him in administering the plan benefits with ease and assurance.
Medicare Member Designated Representative Form
Complete this form if you want someone to act on your behalf. To prevent unauthorized use, these forms are posted on our Secure Member Portal.
Appointment of Representative Form
You can name a relative, friend, advocate, doctor, or someone else to be your appointed authorized representative. This will give that person the right and ability to act for you. Some other persons may already be authorized under state law to act for you. If you want someone to act for you, then you and the person you want to act for you must sign and date a statement that gives this person legal permission to act as your authorized representative.
Send completed forms to Advantra Savings (MSA) at:
Advantra Savings (MSA)
Coventry Health Care, Inc.
Attention: Claims and Customer Service
P.O. Box 7154
London, KY 40472-7154
For questions about any of these forms, please call Advantra Savings (MSA) Customer Service at 1-877-359-5331; TTY/TDD users should call: 1-866-386-2335, Monday through Friday, 8:00 a.m. - 10:00 p.m., ET. From November 15th through March 1st, additional Saturday hours, 8:00 a.m. - 4:00 p.m. ET.
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