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EMPLOYER GROUP APPLICATION (Becomes part of the Group Agreement) COMPANY NAME GROUP NUMBER (Office Use) STREET ADDRESS (No P.O. Boxes) DIVISION NUMBER (Office Use) CITY STATE ZIP REQUESTED EFFECTIVE

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What is employer group application rev1?

Employer group application rev1 is a form that employers need to fill out in order to apply for group health insurance coverage for their employees.

Who is required to file employer group application rev1?

Employers who want to provide group health insurance coverage for their employees are required to file employer group application rev1.

How to fill out employer group application rev1?

Employer group application rev1 can be filled out online through the designated platform. The application will require detailed information about the company and its employees.

What is the purpose of employer group application rev1?

The purpose of employer group application rev1 is to collect necessary information from employers in order to determine their eligibility for group health insurance coverage.

What information must be reported on employer group application rev1?

Employer group application rev1 requires information such as the company's name, address, number of employees, employee demographics, and previous health insurance coverage details.

How do I complete employer group application rev12002 online?

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