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Employee Health Statement

WEBResidual effects. Name and address of attending Physician or hospital (including zip) Union Security Insurance Company. Mail to: P.O. Box 981624, El Paso, TX 79998-1624. T …

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URL: https://www.slfserviceresources.com/forms/admin/KC4887NH.pdf

Form download and instructions

WEBForm download and instructions . The Forms Index below allows you to quickly download and print commonly used forms. The forms with a icon provide fillable fields that you can …

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Provider services

WEBProvider services PPO ® provider services. If you are interested in information about joining our PPO networks - Assurant® Dental Network, Assurant Focus Dental Network® or …

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Visit vsp.com Using your vision plan Answers anytime, …

WEBUsing your vision plan 1. Review your plan information 2. Choose a VSP doctor online or by phone 24 hours a day 3. Make an appointment and let the office know you are a

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Dental Plan FAQ's

WEBWhat Preferred Provider Organization (PPO) Networks do you offer? We offer the Assurant ® Dental Network and the Assurant Focus Dental Network ®.Our PPO networks include …

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Employee Health Statement

WEBUnion Security Insurance Company Mail to: P.O. Box 981624 El Paso, TX 79998-1624 Form 73 (4/2009) RI KC4887RI (5/2016) Employee Health Statement Please print …

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PPO Network Comparison Tool

WEBZelis Network Analytics data as of July 2022 and based on unique dentist count. Sun Life's dental networks include its affiliate, Dental Health Alliance, L.L.C.® (DHA), and dentists …

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HIPAA form instructions » Sun Life

WEBOur forms are available in Portable Document Format (PDF). To view the forms, you may need to download the latest version of Adobe ® Acrobat ® Reader available at …

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Instructions and Helpful Hints for Completing the HIPAA …

WEBRelationship of personal representative to the person or nature of authority. If you have a power of attorney or other court order applicable to authorization, please mail or fax a …

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UNION SECURITY INSURANCE COMPANY P.O. Box 981624, El …

WEBUNION SECURITY INSURANCE COMPANY P.O. Box 981624, El Paso, TX 79998-1624 T 800.733.7879 F 888.208.2323 Employee Health Statement Employee name (last, first, …

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Request to Amend or Correct Protected Health Information

WEBInsurance products are underwritten by Union Security Insurance Company (USIC) (Kansas City, MO) and administered by Sun Life Assurance Company of Canada (SLOC) …

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We have a new web address

WEBWe have a new web address. Assurant Employee Benefits is now part of the Sun Life Financial family and our web address has changed to www.slfserviceresources.com. …

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KC4152F Medical Underwriting

WEBTitle: Microsoft Word - KC4152F Medical Underwriting - HIPAA Authorization for Release of Protected Health Information.dot Author: tm24132 Created Date

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HOSPITAL CONFINEMENT INDEMNITY (GAP) CLAIM FORM

WEB3130 Broadway PO Box 418131 Kansas City, MO 64141-8131 Phone: 800-648-8624 Fax: 816-968-0575 Email: [email protected]. CHECKLIST. Complete STATEMENT OF …

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KC4152ACA HIPAA Authorization for Release of Protected …

WEBTitle: Microsoft Word - KC4152ACA HIPAA Authorization for Release of Protected Health Information - California Residents.dot Author: sl28 Created Date

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Accelerated Benefi t Claim Statement—Insured/Spouse

WEBAccelerated Benefi t Claim Statement—Insured/Spouse Sun Life Financial PO Box 973050 El Paso Texas 79997-3050 T 800.451.4531 F 816.881.8967 Page 1 of 8 KC3932A …

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Wellness / Cancer Screening Claim Statement

WEBT 877.820.5306 F 866.376.9480. [email protected]. Page 1 of 3. KC4916 (7/2017) For your protection, the following disclosures are required by state law …

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