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The Prudential Insurance Company of America fax number

(877) 605-6671

Group Medical Underwriting

Used for: Submission of Evidence of Insurability (EOI) forms for group medical coverage; fax completed forms to 877-605-6671 or mail to the Group Medical Underwriting department.

Fax destination details

Department
Group Medical Underwriting
Purpose
Submission of Evidence of Insurability (EOI) forms for group medical coverage; fax completed forms to 877-605-6671 or mail to the Group Medical Underwriting department.
Form
Short Form Health Statement — Short Form Health Statement (Evidence of Insurability)
Address
The Prudential Insurance Company of America, Group Medical Underwriting, P.O. Box 8796, Philadelphia, PA 19176

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
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Fill out the form in blue or black ink, sign and date it, and include any required medical information. Mail to The Prudential Insurance Company of America, Group Medical Underwriting, P.O. Box 8796, Philadelphia, PA 19176, or fax the completed form to 877-605-6671.

Official form instructions are published as a downloadable file on the organization's website.

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