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Return this form to: Coventry Health Care, Inc. Attn: Enrollment Dept P.O. Box 7756 London, KY 40742 Toll Free Fax Number: (866) 294-4301 Toll Free Voice Number: (866) 364-5663 CONTRACT TERMINATION
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What is health america enrollment form?
The Health America enrollment form is a document used to enroll in health insurance coverage with Health America.
Who is required to file health america enrollment form?
Individuals who want to enroll in health insurance coverage with Health America are required to file the enrollment form.
How to fill out health america enrollment form?
To fill out the Health America enrollment form, you need to provide personal information such as name, address, date of birth, and contact details. You may also need to provide information about your current health insurance coverage, income, and any dependents.
What is the purpose of health america enrollment form?
The purpose of the Health America enrollment form is to gather all necessary information from individuals who wish to enroll in health insurance coverage with Health America.
What information must be reported on health america enrollment form?
The information that must be reported on the Health America enrollment form includes personal details (name, address, date of birth), contact details, current health insurance coverage, income, and information about any dependents.
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