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Claim Forms & Instructions

INTENSIVE CARE / CORONARY CARE CLAIMS (policy or rider)
  • Use claim form C101.
  • Complete the section entitled "Claimant's Statement". Please be sure to date and sign in the blanks provided at the bottom of the form.
  • Submit the hospital bill that shows the itemized charge for each day of confinement to Intensive Care or Coronary Care.
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