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By clicking on one of the choices below, you may print the form on your computer's printer.
These forms apply to any policy:
 Pay Provider Direct
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If you would like for us to pay the provider directly, please use this form. |
HIPAA Authorization
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If you would like to designate a person or persons to receive information about your policy or claims, please use this form. |
If you have any questions, please call 866-916-7971
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POLICYOWNER SERVICE