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Illinois Department of Insurance 320 West Washington Street Springfield IL 62767-0001 1-866-445-5364 toll -free TDD 217/524-4872 http //insurance. If I intentionally omit or provide false information on or in relation to this application then this policy may be cancelled retroactively in which case any claim I submit may not be paid by the insurer. Illinois. gov Standard Health Employee Application for Small Employers Updated - 08/01/2017 For assistance in completing this application please...
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Springfield IL 62767-0001 is a zip code.
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