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2014 AFFILIATE MEMBER INFORMATION PACKET AND Checklists the primary provider and facilitator of local services, Affiliates are a vital part of the safety net that together we seek to provide. Thank
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As form primary provider is a document that lists the individual or entity responsible for providing primary insurance coverage for a dependent.
The individual or entity who is providing primary insurance coverage for a dependent is required to file as form primary provider.
To fill out as form primary provider, you will need to provide information about the primary insurance coverage, including policy number, provider name, and effective dates.
The purpose of as form primary provider is to identify the primary insurance coverage for a dependent in order to coordinate benefits with other insurance plans.
On as form primary provider, you must report details of the primary insurance coverage, such as policy number, provider name, and effective dates.
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