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MICHIGAN ELECTRICAL EMPLOYEES HEALTH PLAN 6525 Centurion Drive Lansing, MI 48917-9275 Toll-Free: 855-633-4584 (517) 321-7502 Fax (517) 321-7508 APPLICATION FOR ACCIDENT/SICKNESS WEEKLY DISABILITY
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Copy of - application is a duplicate of the original application form that needs to be filed or submitted to the appropriate authority.
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The purpose of the copy of the application is to provide a duplicate record of the original application for record-keeping purposes.
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