| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-01567A | Letter: Request for Assignment of Medical Benefits (Word) | 01/29/2021 | English | No |
| F-01567 | Long-Term Care Insurance Policy - Assignment of Benefits (PDF) | 12/12/2018 | English | No |
| F-01567 | Long-Term Care Insurance Policy - Assignment of Benefits (Word) | 12/12/2018 | English | No |
| F-01567S | Long-Term Care Insurance Policy - Assignment of Benefits, Spanish (PDF) | 12/12/2018 | Spanish | No |
Last revised September 24, 2026