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Plan Transfer FormB4143 Utica/Rome PPO Y16 A nonprofit independent licensee of the Blue Cross Blue Shield Association PO Box 546, Buffalo, NY 14201 Phone: (877) 8839577 TTY: (800) 4211220 Name of

How to fill out utica-rome ppo

How to fill out utica-rome ppo

1. To fill out the Utica-Rome PPO, follow these steps: 1. Start by providing your personal information such as your name, address, and contact details.
2. Next, enter your policy information including your policy number and effective date.
3. Fill out the section for primary insured information if you are the primary member of the plan. Otherwise, provide the necessary details for the primary insured individual.
4. Indicate the coverage period and select the appropriate coverage level and plan type.
5. If you have any dependents covered under the plan, provide their details in the designated section.
6. Review the provided information for accuracy and completeness.
7. Sign and date the form to confirm that the information provided is true and accurate.
8. Submit the filled-out Utica-Rome PPO form to the relevant insurance company or designated party as instructed.

Who needs utica-rome ppo?

1. Utica-Rome PPO is suitable for individuals or families who are looking for a Preferred Provider Organization (PPO) health insurance plan in the Utica-Rome area.
2. This type of plan may be beneficial for those who prefer flexibility in choosing healthcare providers and want the option to see specialists without a referral.
3. People who frequently require medical services and prefer a wider network of healthcare providers often opt for PPO plans like Utica-Rome PPO.

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