Common use of EVIDENCE OF COVERAGE AND DISCLOSURE FORM Clause in Contracts

EVIDENCE OF COVERAGE AND DISCLOSURE FORM. An Evidence of Coverage and Disclosure Form booklet and any applicable Supplements will be issued by Blue Shield for all Subscribers covered under this Group Health Service Contract. The following pages contain the exact provisions of this Evidence of Coverage and Disclosure Form and any applicable Supplements and are included as part of this Contract.

EVIDENCE OF COVERAGE AND DISCLOSURE FORM. An Evidence of Coverage and Disclosure Form booklet and any applicable Supplements will be issued by Blue Shield for all Subscribers covered under this Group Health Dental Service Contract. The following pages contain the exact provisions of this Evidence of Coverage and Disclosure Form and any applicable Supplements and are included as part of this Contract.