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Ask general questions, request an identification card, or contact us for a quote for your company.

Select an appropriate form below and fill it out, or call us at 800-332-1168.

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General Question

Member ID Card Request

Member Third Party Liability Information:

If you received a request from either CNIC or UMR for Third Party Liability Information please complete the form below. By completing this form a determination can be made as to whether CEBT or some other entity is the primary payor responsible for claims that have been submitted.

  • Yes

    No

Member’s Dependent(s) Other Insurance Information:

If you received a request from either CNIC or UMR requesting Dependent(s) Other Insurance Information please complete the form below. By submitting this information a determination can be made as to which coverage is primary for your dependents if they have multiple coverages.

  • Yes

    No

Employer Supply Request

Please complete the form below and we will get the requested supplies to you as soon as possible. Thank you.