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Employee Application for Group Coverage Applications must be received within 31 days of the eligibility date. Applications not completed in full will not be processed. Employer Name: Group Number:
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It is a specific form used for reporting employee group information.
Employers are required to file this form.
The form must be completed with accurate employee group data as per the instructions provided.
The purpose is to report employee group information for compliance and regulatory purposes.
Details such as employee group size, demographics, and other relevant data need to be reported.
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