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Get Uhc Reimbursement Form

Ustomer Service Phone: (877) 311-7849 Complete Part 1 entirely and legibly. If you do not know your Subscriber ID, Group Number or have a change of address, please contact your benefits administrator. Complete Part 2 if you are claiming health care expenses (medical, dental, hearing, vision, prescription or over-thecounter medications). Complete Part 3 if you are claiming dependent care expenses. Carefully read and follow the directions below regarding the Provider s Certification of Servic.

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