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We pay claims fast. <> 46a&g>*Zg/Di4fH;%L. A&!R^maAJpBZW3)>! 23 0 obj <> >> <> /XObject << Upload the PDF you need to design. U;s(7Es'Hq&:@a]^0oUGCJa3R7thK`//"XdS%5f,bl:[\>V0EGJX9:R[P$&(L2fO4E"!r*bnZA.0JbrSKY5@2H. 16 0 obj 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` Please complete the Patient section, Boxes 818, as well as the Policyholder/Employee section (excluding Boxes 3138 and 40.) <> endobj 16 0 obj 5 0 obj @oGDmsuR- 0000001020 00000 n 0000037564 00000 n For step-by-step tutorials on filing an online claim, please see our claims checklists. 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