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University of Texas HEALTH SCIENCE CENTER SAN ANTONIO 10151914 Medical 20142015 Student Health Insurance Plan 10614514 Dental SPRING Enrollment Form for Deaf Education Students *0670090114* Enrollment
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It is a form used for reporting individual health insurance coverage.
Individuals who have purchased health insurance coverage on their own are required to file this form.
The form must be filled out with information about the individual health insurance coverage purchased.
The purpose of the form is to report individual health insurance coverage to the IRS.
Information such as the policyholder's name, policy number, and coverage dates must be reported on the form.
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