Webcritical illness claim form . attending physician’s statement . patient’s name date of birth date of death (if applicable) when did signs and/or has the patient ever received medical advice or diagnosis (including complications) WebCustomer Service Center P.O. Box 2048 Columbia, SC 29202 [email protected] This brochure is a brief description of cover age and is not a con - tract. Read your certificate carefully for exact terms and condi-tions. This brochure is subject to the terms, conditions and lim-itations of policy form series HML9800-MP.

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