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INSURANCE APPLICATION EMPLOYER APPLICATION FORM 417 Washington Street Columbus, IN 47201 8004432980 GROUP #: Effective Date: Employer Information Legal name of Business: Billing/Mailing address: City:
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Group - siho is a form for reporting information related to health insurance coverage provided by an employer to their employees.
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The purpose of group - siho is to provide information to the IRS about the health insurance coverage offered by employers.
Group - siho must include information about the employer, the employees covered, and the type of coverage offered.
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