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  • Fsl Hospital Confinement Indemnity (gap) Claim Form 2019

Get Fsl Hospital Confinement Indemnity (gap) Claim Form 2019-2025

4) 291-1301 fax Email: customerservice specialinc.com CHECKLIST 1. 2. 3. Complete STATEMENT OF INSURED below, answering all questions fully. ATTACH EXPLANATION OF BENEFITS (EOB) provided by the insurer for your Comprehensive Major Medical Plan, if applicable, to this claim form. Return this claim form, all itemized bills and EOBs to the address shown above. STATEMENT OF INSURED Your Name Male Policy Number Social Security Number Your Address (Number and Street) Phone Number City St.

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METLIFE'S HOSPITAL INDEMNITY INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states.

Visit mybenefits.metlife.com or download the MetLife Mobile App to view your certificate of insurance and to initiate your claim* or call 866-626-3705 to obtain a claim form*. Answer some questions about your claim and upload your medical documentation to support your claim. The whole process takes justminutes!

Visit mybenefits.metlife.com to access and submit your claim form electronically. You may also call MetLife at 866-626-3705 to request claim forms to be sent via mail. 2. Please provide supporting documentation from the hospital related to the services received for which a claim is being made.

Coverage Details Coverage LevelAmount You ReceiveLow OptionHigh OptionHospital Admission (per confinement)$600$1,200Hospital Confinement (per day)$150$250Hospital Intensive Care (per day)$150$250

Making a claim Our claims team can be contacted Monday to Friday 9am to 5pm on 0800 917 1222. When an employee is absent from work due to illness or injury, there's a lot for employers to think about, for example redistributing workloads, contacting customers and so on.

Insured is the person who is covered against risk. On the other hand, the insurer is the company that is providing coverage. It is a service that an insurer provides under a particular insurance policy against a premium paid by the policyholder.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232