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One Number Address (street, city, state, zip code): ITEMS REQUESTED 1. MEDICAL: Please send me a Medical Option Change Form and the following items: Note: All HMO packets include applications. Kaiser Foundation Health Plan Packet (HMO - Actives and Pre-Medicare Retirees). (Calif.) Kaiser Senior Advantage Packet (HMO - Medicare Retirees). (Calif.) PacifiCare Packet (HMO - Actives and Pre-Medicare Retirees). (Calif.) PacifiCare SecureHorizons Packet (HMO - Medicare Retiree.

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