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Get Manulife GL5197E 2013-2024

list under your drug plan benefit coverage. Please ensure this form is filled in completely or it will delay the processing of your request. Completion of this form is not a guarantee of approval. If you have already purchased the drug, please attach all original receipts along with an Extended Health Care Claim form. All costs incurred to complete this form are the plan member’s responsibility. If you are registered for the Plan Member Secure Site and have provided an email address, you will.

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