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Beneficiary Claim Form

Beneficiaries filing their own medical claim must use DD Form 2642. Be sure to attach a copy of the provider’s itemized bill to the claim form.

Tip for Chrome users: If you are unable to open the form using the link above, hover over "View >>" below, right click and select "Save link as." Once saved locally, you can open the form. 

  • Created: Aug 1, 2022
  • Modified: Feb 20, 2019
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