Common Contracts
1 similar null contracts
Group Medicare Supplement Plan G Washington Health Care AuthorityJanuary 4th, 2021
Please find enclosed • Outline of Medicare Supplement Coverage • Group Medicare Supplement Enrollment Application/Eligibility Attachment (see State Residents) • Automatic Funds Transfer Agreement (authorization for automatic payment program) • Notice to Applicant regarding replacement of Medicare Supplement Coverage • Release of information authorization form (only necessary of you would like to authorize another person to have access to your information) What’s next? Submit your completed application/eligibility attachment and any other information via• Fax to: 425-918-5278• Mail to:PO Box 327, MS 295Seattle, WA 98111
