Reaching Us By Phone:
You can call a DRL Service Representative and get answers to your questions at 1-800-564-7227 Monday though Friday 8:30 am to 4:30 pm.


Corporate Office:
105 S. York Rd.
Suite 230
Elmhurst, IL. 60126
630-379-0851
630-379-0857 (fax)


Request For Information Form:

*First Name
*Last Name
*Address
*City
*State
*Zip
*Email
*Phone
	The information below is only required if you are requesting information for the Blue Cross and Blue Shield of Illinois Comprehensive Major Medical programs (Under age 65)
Date of Birth
Smoker (Yes/No)
Spouse's Name
Spouse's Date of Birth
Spouse Smoker (Yes/No)
# of Children
Names
Ages
	Please send me information on the following: (check as many as you like by holding down the CTRL key)
IMRF Endorsed Programs	Pacificare Seniors Choice Pacificare Senior Security Pacificare Platinum Premier Blue Cross and Blue Shield of Illinois Supplemental (Over 65) Humana Fee for Service Mercy Health Plans United Healthcare Medicare Complete Health Alliance Life Investors Long Term Care Plans Blue Cross and Blue Shield of Illinois Major Medical Programs (under 65) SavRx Prescription Discount Card Delta Dental SPECTERA Vision Plan
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