For State of Maine Employees (SOM) (click links below):
Print and fill out the application and authorization forms and return by fax to Phonse at 207-620-8283 or by US mail to:

     Medical Care Development
     ATTN: Phonse Allen-Laney
     11 Parkwood Drive
     Augusta, ME 04330

Any questions, call Phonse at 207-622-7566, ext. 252. ALL INQUIRIES ARE CONFIDENTIAL.

    TDES²! Application

    TDES²! Authorization Form

    TDES²! Benefit Fact Sheet

For more health insurance benefits click here http://www.maine.gov/beh/