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Get Health Reimbursement Arrangement Claim Form - Upmc Health Plan

HEALTH REIMBURSEMENT ARRANGEMENT CLAIM FORM Mail to UPMC Health Plan PO Box 2999 Pittsburgh PA 15230 PLAN AND EMPLOYEE INFORMATION LAST NAME E-MAIL PLAN YEAR FIRST NAME DAYTIME PHONE EMPLOYER NAME Phone 1-866-328-8762 No. of pages MEMBER ID NUMBER DATE OF BIRTH EMP ID Note Reimbursements will be sent to the address on file with UPMC.

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