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Policy Information

Policy Information

When accessing the Health and/or Dental claim form please use the below information as a guide to complete the required sections of the form: 
  • Plan Number: 123456
  • Division Number: Not Applicable Leave Blank
  • Plan Name: SCHOOL
  • Employee Identification Number: Your Student ID
  • Employee Name & Address: Your Name & Current Mailing Address 

You are required to submit original copies of your claim form, receipts and doctor's referral (if required) when sending in your claim to the insurance carrier. Remember to always keep copies for your records.

Service Members

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