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Hsainsurance.com HARVARD PILGRIM HEALTH CARE 2013 Plan Change Form COMPANY (Correct Legal Name) ACCOUNT NO COMPANY S BUSINESS ADDRESS (Street, City, State, Zip Code) TELEPHONE () COMPLETE THIS FORM
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The Com Harvard Pilgrim Health is a form that must be completed by certain individuals or entities to report health insurance coverage.
Employers, insurance companies, and other entities that provide health insurance coverage are required to file the Com Harvard Pilgrim Health form.
The Com Harvard Pilgrim Health form can be filled out electronically or on paper, following the instructions provided by the IRS.
The purpose of the Com Harvard Pilgrim Health form is to report information about health insurance coverage provided to individuals during the tax year.
The Com Harvard Pilgrim Health form requires reporting of the individual's name, address, Social Security Number, and the months for which they had coverage.
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