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HOME
LIFE, LTC & VISION PLANS
PROVIDERS
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No Surprises Act
MEMBERS
Information Requests
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Member Contact Us
Forms
SECURE FILE UPLOAD
CONTACT US
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REPORTING FRAUD
HOME
LIFE, LTC & VISION PLANS
PROVIDERS
Information Requests
Submitting Claims
Provider Manual
Provider Contact Us
Provider News
No Surprises Act
MEMBERS
Information Requests
Plans and Policies
Member Contact Us
Forms
SECURE FILE UPLOAD
CONTACT US
PRIVACY PRACTICES
REPORTING FRAUD
Forms
Change Your Communication Preferences
(pdf)
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Member Reimbursement Claim Form
(pdf)
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COVID-19 Test Reimbursement Claim Form
(pdf)
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International Claim Form
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MedImpact Claim Form
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Designation of Health Insurance Representative
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End Designation of Health Insurance Representative
(pdf)
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Participant Request for Health Insurance Information
(pdf)
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WEA Grievance Procedure
(pdf)
Download
Authorization to Share Health Information with a Third Party
(pdf)
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