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Webintercepted by an unauthorized party is encouraged to submit their form by other means. Mail to: The Great-West Life Assurance Company Drug Services PO Box 6000 … Webi authorize release of the information contained in this claim form to my insuring company/plan administrator. i also authorize the communication of information related to the coverage of services described in this form to the named dentist. part 2 employee information at great-west life, we recognize and respect the importance of privacy. WebI authorize Great-West Life, any healthcare provider, my plan administrator, other insurance or reinsurance companies, administrators of government benefits or other … chili garlic oil producers in the philippines