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You can get the information and care that you need quickly with these commonly-requested forms.
At some point during your care, you may want us to disclose your protected health information to someone else, like a partner or child. Here you’ll find the form you’ll need to authorize the release of that information.
If you're looking to be reimbursed for eligible out-of-pocket medical expenses, be sure to submit this reimbursement request form within 180 days of the date of service.
Let us know if you're having any problems with your current plan or plan provider so we can help. Here's how to file a formal complaint or appeal.
Members who participate and complete a smoking cessation class or program will be reimbursed up to $100 per class or program per calendar year. Download the form below for more information.
Download our privacy practices ➜
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