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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Blue Cross Medicare Rx (PDP)SM c/o Pharmacy Benefit Manager 1305 Corporate Center
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To fill out pdp-cov-determ-il-2018 p - blue, follow these steps:
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Start by entering your personal details in the designated sections, such as name, address, date of birth, etc.
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Proceed to provide information related to your current health insurance coverage, including the name of your insurance company and policy number.
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Individuals who require pdp-cov-determ-il-2018 p - blue are those who are seeking a coverage determination from their health insurance company in the state of Illinois.
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pdp-cov-determ-il- p - blue refers to the insurance coverage determination form for individuals in the state of Illinois.
Individuals who are seeking insurance coverage in Illinois are required to fill out and file pdp-cov-determ-il- p - blue.
To fill out pdp-cov-determ-il- p - blue, individuals need to provide personal information, details about the insurance policy they are seeking, and any other relevant information requested on the form.
The purpose of pdp-cov-determ-il- p - blue is to help individuals determine their insurance coverage options and eligibility in the state of Illinois.
Information such as personal details, insurance policy information, and any other relevant information requested on the form must be reported on pdp-cov-determ-il- p - blue.
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