File name: Guardian Claim Form Pdf
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Fast, Easy & Secure · Trusted By Millions · Paperless Solutions · Paperless WorkflowService catalog: Document Management, Electronic Signatures, Cloud Storage. The laws of several states require the following statements to appear on the claim form: Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit . Use the tabs below to find the right forms for you. If you can’t find what you’re looking for, check the page and give us a call! Click here to view and download a complete list of Guardian . Guardian Members, Providers and Brokers can download the appropriate forms such as those used for claims, credentialing, MDG, dispute, speciality referral, W9 and Broker Agreements. If you would like to have your Supplemental Health (Accident, Cancer, Critical Illness and Hospital Indemnity) benefit payment directly deposited into your bank account, please complete the attached DIRECT PAY ENROLLMENT AND AUTHORIZATION form. The form is designed so that the Primary Payer's name and address (Item 3) is visible in a standard #10 window envelope. Please fold the form using the 'tick-marks' printed in the left and right margins.