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I have been hospitalized. I want a Certificate of Application of Maximum Copayment Amount, but what should I do?

To have a Certificate of Application of Maximum Copayment Amount issued, it is necessary to submit an application form. This application form can be submitted either by mailing it to us or by attaching it to an email to apply.
To send the application form via email, fill out the PDF application form, save it to your computer, and then send it as an email attachment. The recipient's email address is indicated at the upper left corner of the Application Form of Issuance of Maximum Copayment.


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