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Get University Of California Uben 101 2020-2024

Er in a UC medical plan and either you or your covered family member(s) is in Medicare, this form needs to be completed when you: Disenroll/cancel a Medicare family member from your plan Suspend your medical plan which covers a Medicare member or Disenroll from any Medicare plan and enroll in UC Medicare PPO without Prescription Drugs Return this completed form to UC or the Medicare plan you are leaving and make a copy for your records. S end to UC if you are in the following.

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