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Aetna
PO Box 981106
El Paso, TX 79998HEALTH INSURANCE CLAIM FORM
APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE (NCC) 02/12
PICA(Medicare #)MEDICAIDTRICARECHAMPVA(Medicaid #)(ID#/DoD#)(Member
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PO Box 981106 is a specific address designated for mail delivery purposes.
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Individuals or entities who are assigned PO Box 981106 as their mailing address are required to file it.
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PO Box 981106 should be filled out with the correct information and used for sending or receiving mail.
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