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For your convenience, we have pre-written letters that may be of interest to you available to download.


Select the letter that best suits your needs. Please submit your completed letter to the address indicated on the letter.


If you have any questions or require assistance with completing your letter, please contact one of our professionals

Qualified Medical Child Support Order

To avoid duplication of payments, your plan includes provisions to coordinate benefits which your dependents may have from another group plan.


Student Verification Letter

This form should completed by customers with dependents that have exceeded the maximum age limit for coverage, in order to provide verification of full-time student status.


Accident Letter

Before certain claims can be processed, this additional information needs to be provided.


ESRD Medicare

This form should be completed in order to determine claim payment responsibility.


Conditions for Newborn Infant Coverage Letter

This form should be completed before charges for a newborn infant will be considered.


Annual Questionnaire Regarding Other Coverage

Standard information we need every year to keep your information current.