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Get INDEPENDENT PROVIDER PACKET

Vider Packet. Please review the enclosed Information Page that contains the requirements to approve an IP. Please return the completed forms to our office along with the necessary supporting documentation. You may return the completed forms to us via fax to 1-866-294-6967 (preferred) or mail to CalPERS LongTerm Care Program, P.O. Box 64902, St. Paul, MN 55164. We will advise you, in writing, when a decision is made concerning your eligibility for benefits, and whether coverage for the IP you hav.

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