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Cagney Healthcare of Illinois, Inc. INDIVIDUAL AND FAMILY EVIDENCE OF COVERAGE Cagney Connect 2500 and Native American / Alaskan Native Over 300% Plan THIS EVIDENCE OF COVERAGE MAY NOT APPLY WHEN
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Indicate whether you are the primary policyholder or if you are filling out the form on behalf of someone else.
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il-cigna-connect-2500-mihm0149-0150-0155 is a specific form used for reporting certain information related to Cigna healthcare coverage.
Employers and insurers who provided Cigna healthcare coverage are required to file il-cigna-connect-2500-mihm0149-0150-0155.
il-cigna-connect-2500-mihm0149-0150-0155 can be filled out electronically or by paper, following the instructions provided by the IRS.
The purpose of il-cigna-connect-2500-mihm0149-0150-0155 is to report information about Cigna healthcare coverage to the IRS.
Information such as the names and social security numbers of covered individuals, the months of coverage, and any applicable codes must be reported on il-cigna-connect-2500-mihm0149-0150-0155.
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