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THE LOCAL CHOICE (TLC) HEALTH BENEFITS PROGRAM APPEAL FORM Department of Human Resource Management (DRM)Persons enrolled in TLC statewide plans may use this form to appeal adverse claim determinations
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Form Local Choice Health is a form that allows individuals to choose their health care provider locally.
Anyone who wishes to select a health care provider locally is required to file form Local Choice Health.
Form Local Choice Health can be filled out by providing personal information and selecting a health care provider from the local network.
The purpose of form Local Choice Health is to give individuals the option to choose a health care provider within their local area.
Personal information and the selected health care provider must be reported on form Local Choice Health.
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