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This page contains links to the claim forms available for printing for claims prior to January 1, 2008. Click on the appropriate form to download, view, and print.
> In
order to view these PDF files you will need the Adobe Reader. 
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Prior to January 1, 2008 Benefits & Eligibility administered by A&I Benefit Plan Administrators, Inc. | |
This page contains links to the claim forms available for printing for claims prior to January 1, 2008. Click on the appropriate form to download, view, and print. |
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| Select Plan Medical Claims |
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| Choice
Plan Medical Claims |
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| Pharmacare Mail Order Prescriptions Enrollment Form |
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| > In
order to view these PDF files you will need the Adobe Reader. |
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| All information provided on this web site is in summary and intended to provide highlights of your plans. We strongly recommend referring to the Plan booklet for complete details before making any decisions related to your eligibility, benefits and coverage. | ||