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HealthCare. gov do not use this form to cancel your plan you may cancel your plan at www. HealthCare. Please submit the form timely otherwise it may result in a refund for overpayment of premium. Send to Health Tradition Health Plan PO Box 188 La Crosse WI 54602-0188 Fax Email 608-781-9653 Contact HealthTradition.com Please complete print and submit. Print Reset Form Member Information Last Name First Name Member ID Number MI Date HTW Mailing Address City State / Zip Code Insurance...
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