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Get Medicare Supplement Plan F (Form B) - Health Care Authority - Hca Wa

Become a Washington State Health Care Authority Medicare Supplement member if you: Are eligible for the group s Medicare supplement plan Currently have both Medicare Part A and Part B, and Don t receive Medicaid assistance other than payment of your Medicare Part B premium. For Office Use Only Group Number: Effective Date of Coverage: / / Enrollee Class (if applicable): Please PRINT, sign and date in.

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