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4607-0783-2208 1A PERF CANCELLATION AUTHORIZATION FORM 2 Return via fax to Group Name 404-842-8040 Group Number Completed By Page Title Employee Member No. Telephone Last Name MI Cancellation Effective Date Coverage being Canceled Medical Dental Life Cancel employee YES NO If yes Left Employment Other Coverage Please note Canceling the employee s coverage will cancel coverage for ALL dependents. Reason Date of Death Cancel all dependents YES NO ...
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What is blue crossblue shield cancellation?
Blue Cross Blue Shield cancellation refers to the process of terminating a Blue Cross Blue Shield insurance policy.
Who is required to file blue crossblue shield cancellation?
Any individual or entity who wishes to cancel their Blue Cross Blue Shield insurance policy is required to file a cancellation request.
How to fill out blue crossblue shield cancellation?
To fill out a Blue Cross Blue Shield cancellation, you will need to contact your insurance provider and follow their specific cancellation procedures.
What is the purpose of blue crossblue shield cancellation?
The purpose of Blue Cross Blue Shield cancellation is to terminate an insurance policy and discontinue coverage.
What information must be reported on blue crossblue shield cancellation?
The specific information that must be reported on a Blue Cross Blue Shield cancellation may vary, but it generally includes policyholder details, policy number, effective date of cancellation, and reason for cancellation.
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