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Group Effective Date Check all that apply Medical Delta Dental End Date Group ID Self-Funded Rx CDPHN-Administered Health Funding Arrangement s Flexible Spending Account FSA Health Reimbursement Arrangement HRA Health Savings Account HSA None EMPLOYER INFORMATION Required 1. Capital District Physicians Healthcare Network Inc. CDPHP Universal Benefits Inc. 500 Patroon Creek Blvd. In CDPHP service area 5c. Eligible employees not enrolling in CDPHP Covered through spouse Covered under Medicare...
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