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GHA: High Option Summary of Benefits and CoverageCoverage Period: 01/01/2016 12/31/2016 Coverage for: Self Only, Self Plus One or Self and Family Plan Type: This is only a summary. Please read the
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Subject to form definitions refers to the specific criteria or conditions that must be met for a particular form to be applicable.
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Individuals or entities who meet the criteria outlined in the form definitions are required to file the form.
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