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2. Attach a copy of the pathology report(s) with a positive diagnosis of cancer or a specified disease. Be sure to attach the earliest diagnosis of cancer or specified disease to ensure proper payment of benefits. 3. For Intensive Care Coverage claims only please complete each section of the first page of the claim form and attach a copy of the itemized bill from your hospital stating dates you were billed for intensive care confinement and the diagnosis codes for the confinement. Itemized.

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