19049. 19049 2025

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The document is a Health Benefits Claim Form for the Federal Employee Program, detailing the necessary information required to submit a claim for health benefits. It includes sections for patient information, other health insurance details, Medicare coverage, employment status, diagnosis, and charges incurred. Instructions emphasize the importance of completing each section accurately and attaching itemized bills for services rendered.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (266 Votes)
2014	4.4 Satisfied (195 Votes)
2005	4.4 Satisfied (93 Votes)
1997	3.8 Satisfied (29 Votes)

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