Laserfiche WebLink
GGFM-ER-8514 Maxwell Health Employer Information Form 02/24 <br /> Long-term disability insurance, continued <br />B.Claims checks will be mailed to the employee’s home address <br />If anything different, please specify: ______________________________________________________________ <br />C. Where will monthly claims reports and Explanation of Benefits (EOB) documents be sent? <br /> To primary benefits administrator <br /> Other, please specify below <br />_________________________________________________________________________________________________ <br />D. y If you are a Healthcare Professionals group, and you purchased the Malpractice Insurance Reimbursement Rider, <br />please identify who the benefit should be payable to? Employer Employee Not applicable <br />Docusign Envelope ID: BA987120-63B9-40BD-A4CA-C6E248AD9B65 <br />X <br />X