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Heathen Median Extra (HMO DSP)
2023 OTC Order Former MONTHLY OVERTHECOUNTER
(OTC) BENEFIT IS: $125Formulario de OTC 2023
SU BENEFICIAL SENSUAL PARA
MEDICINAL SIN REC ETAS ES: $1251. Member Information/
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How to fill out 2023-otc-order-form-plan-019-medisun-extra-hmo-d
01
Start by entering your personal information such as name, address, and member ID.
02
Select the items you wish to order from the OTC catalog provided by Medisun Extra HMO.
03
Make sure to check the quantities and sizes of the items you want to order.
04
Fill out the order form with the item codes, quantities, and any other required information.
05
Double-check your order to ensure accuracy and completeness.
06
Submit the filled-out form according to the instructions provided by Medisun Extra HMO.
Who needs 2023-otc-order-form-plan-019-medisun-extra-hmo-d?
01
Individuals who are enrolled in the 2023 Medisun Extra HMO-D plan
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What is otc-order-form-plan-019-medisun-extra-hmo-d?
It is a form for ordering over-the-counter items for the MediSun Extra HMO-D plan.
Who is required to file otc-order-form-plan-019-medisun-extra-hmo-d?
Members of the MediSun Extra HMO-D plan are required to file this form.
How to fill out otc-order-form-plan-019-medisun-extra-hmo-d?
The form can be filled out online on the MediSun website or through mail by selecting the desired items and quantities.
What is the purpose of otc-order-form-plan-019-medisun-extra-hmo-d?
The purpose of this form is to allow members to order over-the-counter items covered by their plan.
What information must be reported on otc-order-form-plan-019-medisun-extra-hmo-d?
Members must report their name, plan details, selected items, and quantities on the form.
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