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UTAH SMALL EMPLOYER EMPLOYEE HEALTH INSURANCE APPLICATION OFFICE USE ONLY Policy / Group No. REASON FOR ENROLLMENT (mark all that apply) New Group Newborn Loss of Coverage Open Enrollment Court Order

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How to fill out utah insurance departmentinsurance made

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To fill out the Utah Insurance Department insurance form, follow these steps:

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Begin by gathering all the necessary information. This may include personal details, policy numbers, insurance company details, and any relevant documents.

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Read the instructions and questions carefully to understand what information is required in each section.

04

Start filling out the form by providing your personal information such as full name, address, contact details, and date of birth.

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Sign and date the form as required.

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Make a copy of the filled-out form for your records before submitting it to the Utah Insurance Department.

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Submit the form according to the provided instructions. This may involve mailing it, utilizing an online portal, or visiting the insurance department in person.

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