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IDENTIFY VISION CHECKLIST POLICY CERT PAGE OR …

VISION CHECKLIST CODE 48 IDENTIFY POLICY & CERT PAGE #, OR LOCATION, OF BENEFIT WITHIN FORM SUBMISSION July 9, 2002 LH48CHK Prior Edition -- July 8, 2002 Page 2 of 5 ♦ Denotes a mandate for which a specific contractual reference is required. • Notice requirements prohibited. • If dependents are covered, the policy or contract must include as

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