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WAIVER OF IMMEDIATE REINSTATEMENT OF FEHB
I,. , was discharged from military service on. , and I qualify for Transitional TRICARE and/or TRICARE Reserve. Select until . Employees: I understand that,
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TRICARE noncovered services waiver
I hereby affirm that I have been informed and I understand that these services are excluded or excludable under the TRICARE program and therefore all costs
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OPERATIONS MANUAL
☐ Read highlighted excerpts from the consent form (attach highlighted form). Page 126. NHBS Tricare. (Champus). VA. Coverage. Text for. Other. Insurance.
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