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C Health Account Services P. O. Box 942715 Sacramento CA 94229 -2715 888 CalPERS or 888-225-7377 TTY 877 249-7442 FAX 800 959-6545 Direct Payment Authorization Form HBD-21 1. It is the employee s responsibility to provide the carrier with a copy of the Direct Payment Authorization form HBD-21 and all payments by the established due dates.

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