FIDELITY SECURITY LIFE INSURANCE COMPANY
SUPPLEMENTAL MEDICAL EXPENSE (GAP) CLAIM FORM. MAIL TO: SPECIAL INSURANCE SERVICES, INC. PO BOX 250349. PLANO, TX 75025-0349 (800) 767-6811 – phone; (214) 291-1301 – fax. Email: customerservice@specialinc.com. All States 10-12. All States 10-12 ................
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