WebExtended Health Care Claim Form. 1 Information about you – be sure to fully complete this section • Use this form for all. medical expenses and services. For dental expenses, please use the Dental Claim Form. • Please print clearly and be sure all sections are complete to avoid delays in processing your claim. • Attach the original WebThis form should be used by qualified beneficiaries to make allowable changes to an existing Extended Coverage/COBRA plan or membership. For initial COBRA enrollment, …
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Benefits & Claims Forms - The Alberta Retired Teachers
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