COBRA & Retiree / Direct Billing - Electronic Submission

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Please note: The uploaded file must be DOC, DOCX, PDF, GIF, JPG, PNG, TIFF or TIF in format. The uploaded file must be less than 10MB in size.

Please note: Renaming a non-supported file tyle to a suported file types will not be accepted. EXAMPLE: myreceipt.png to myreceipt.pdf

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