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Download Allotment Form US Family Health Plan CHRISTUS

Download Allotment Form US Family Health Plan CHRISTUS

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Enrollment. Please complete sign and mail this form and payment to Christus/US Family Health Plan PO Box 842045 Dallas TX 75284-2045 800 678-7347 Page 12 of 12. I hereby authorize this allotment to be taken from my military retirement pay. I understand that it will remain in effect until I request that it be changed or stopped. However as a courtesy to me I also authorize USFHP to automatically stop this allotment at a future date if I become disenrolled from the USFHP for any reason including...
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