Nom Insured Health Services exception request
Catégorie Health and wellness
Dernière mise à jour
Taille 53.1 Ko
Type de fichier pdf
Nombre de pages 2
Description
Use this form to request special authorization for coverage of a drug, medical supply or medical equipment through an Insured Health Services benefit program. Each request is reviewed individually.
Follow the instructions on the form to submit the request. Do not send the completed form by regular email.