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Home > Miembros > Formularios y documentos

Formularios y documentos

Encuentre los formularios y documentos que necesita para aprovechar al máximo su plan médico.

¿Tiene alguna pregunta o necesita ayuda con un formulario? Llame a Servicios al Miembro, las 24 horas al día, los 7 días de la semana, al 1-833-704-1177 (TTY 1-855-534-6730).

  • Autorización para compartir información médica (PDF)
  • Formulario de Solicitud de representante personal (PDF)
  • Solicitud de reembolso por transporte médico en automóvil privado o ferrocarril (PDF)
  • Lista de numeros utiles (PDF)
  • Lista de verificacion de salud optima (PDF)
  • El Conocimiento es Poder (PDF)
  • Solicitud de apelación (PDF)
  • Sus beneficios de transporte (PDF)
  • Programa WeightWatchers® (PDF)
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