P.O. Box 805107 • Chicago, Illinois 60680-4112
Claim Form to Pay Insured/Subscriber P.O. Box 805107 • Chicago, Illinois 60680-4112 Each item on this form needs to be completed. Instructions for …
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The drug list (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. The drugs listed will be covered as long as you:
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DE 2320 Rev. 63 (4-18) (INTERNET) Page 3 of 19 If you served in the military in the last 18 months, you will need to provide information from your DD214 Member copy 4. If you worked for the federal government during the last 18 months, you will need to provide information from your Notice to Federal Employees About Unemployment Insurance, …