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  • Microsoft Word - GGHO-3927l 2016 Customer Service_Viper Worksite. docx
    Access online secure portal where brokers can view block of business and commission statements Employers can administer benefits and pay bills online Members can view claim statuses Providers can view account details
  • Sun Life
    Zelis Network Analytics data as of March 2026 and based on unique dentist count Sun Life's dental networks include its affiliate, Dental Health Alliance, L L C ® (DHA), and dentists under access arrangements with other dental networks Nationwide counts are state level totals
  • KC4579A - slfserviceresources. com
    The Company will make payment to the trustee under the insured’s last will and testament if it receives at its home office, within one year after the date of the insured’s death, evidence satisfactory to it that the trustee is authorized to receive payment under applicable law If no evidence is received within that period, payment will be made to the executors or administrators of the
  • Microsoft Word - KC4916_06Nov2013_New. doc
    You must include the name of the provider of service, the type of service and the date of service Submit this form to the address, fax number or e-mail address stated at the bottom of this form
  • KC3661A - slfserviceresources. com
    EMPLOYER SECTION Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), Plan Administrators (the employer) are responsible for administering COBRA continuation coverage You may use this form to inform us of the intention of a qualified individual to continue group dental coverage Please complete the employer section of this form and have the qualified individual
  • Dental Claim Statement
    Dental Claim Statement 2016 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481 All rights reserved Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada Visit us at www sunlife com us KC2147ANY (10 2016)
  • kc4678. indd - slfserviceresources. com
    I authorize any provider of medical services, insurance company, consumer reporting agency, Social Security Administra-tion, governmental agency, educational institution, law enforcement agency or employer having medical information with respect to any physical or mental condition, rehabilitation and other non-medical information of me to give
  • KC4739FSL - slfserviceresources. com
    authorize the disclosure of any and all information that: (i) is created or received by a health care provider, health plan including health insurer or health insurance agent, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (ii) relates to the past, present, or future physical or mental health or condition of an individual listed above
  • Disability Claim Statement—Life Insurance
    If you live in New York the following statement applies to you: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a
  • KC3932A_201702. indd
    A person who knowingly and with intent to injure, defraud, or deceive an insurance company fi les a claim containing false, incomplete, or misleading information may be prosecuted under state law





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