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RETURN BY 4/1/04 THE LOCAL CHOICE HEALTH BENEFITS PROGRAM EMPLOYER DATA SHEET Please complete all applicable information and return this sheet to the address shown below. You will receive a letter
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Provide accurate information regarding your current health insurance coverage, including policy details and coverage dates.
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Form Local Choice Health is a form used to report health insurance coverage for individuals in a specific jurisdiction.
Employers and health insurance providers are required to file form Local Choice Health.
Form Local Choice Health can be filled out online or submitted through mail with all relevant information about the health insurance coverage.
The purpose of form Local Choice Health is to ensure compliance with local requirements regarding health insurance coverage.
Information such as the name of the individual covered, the type of coverage, and the duration of coverage must be reported on form Local Choice Health.
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