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Ce that are your responsibility, please refer to your Evidence of Coverage booklet. Note: If your primary coverage is through another medical plan, you MUST file your claim with that plan first. If there is a balance remaining, after your primary medical plan pays your claim, you may file a claim for Kaiser Foundation Health Plan to pay the difference. Complete the attached Claim for Emergency Medical Services form and mail it along with a copy of your other plan’s paid explanation of benefits.
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