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Claims Reimbursement

To request claims reimbursement for a covered service, download the Claims Reimbursement Form below. Send the completed form and a copy (not the original) of the provider’s bill to:

HealthMarkets Care AssuredSM Plan

The Chesapeake Life Insurance Company

PO Box 69349

Harrisburg, Pa 17110

ATTENTION: CLAIMS SERVICES


Claims Reimbursement Form

CMS APPROVAL 11/24/2007
H7845_MM_NA_E_4006_3_ALL

Underwritten by

The Chesapeake Life Insurance CompanySM