MVTA Benefit Trust Forms
Click the link below to dowload the desired form:
As always, before committing to dental treatment that may be expensive,
have your dentist submit a predetermination of benefits
so that you are aware of what your out-of-pocket cost will be.
If you have any questions or need help filling out your form(s)
please contcat your building level Benefit Trust representative:

Mike Conklin – IS    ext. 4206   email:

Tom Cosgrove – HS    ext. 1225   email:

Melanie Speranza – MVTA    ext. 4305    email:

Amy Sicina – MS    ext. 3227    email:

Karen Krogslund – OTIS    ext. 2142   email:

Cliff Loretto – ES    ext. 4303   email: