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Cagney Healthcare of Illinois, Inc. INDIVIDUAL AND FAMILY EVIDENCE OF COVERAGE Cagney Connect 3400 THIS EVIDENCE OF COVERAGE MAY NOT APPLY WHEN YOU HAVE A CLAIM! PLEASE READ! This Evidence of Coverage
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It is a specific form for reporting health insurance coverage.
Individuals or entities that provided health insurance coverage.
You can fill out the form with the required information regarding health insurance coverage.
The purpose is to report health insurance coverage to the relevant authorities.
Information such as the name of the insured, months of coverage, and policy number.
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