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Get NC BCBS Form BE236 1999

Complete a separate claim form for each covered family member. Type or print legibly. Enclose receipts and make copies for your records. Do not file prescription drugs on this form. See the back of the form for filing information. Do not file a claim if the Provider or Hospital is filing for the same services. Attach Explanation of Benefits if these services are covered by another group health policy. Mailing instructions are included on the back of this form. SECTIO.

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