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MPH INSTITUTE OF HEALTH PROFESSIONS National Guardian Life Insurance Company Student Medical Plan 20182019 Termination Request Form Uses THIS FORM TO REQUEST TERMINATION FROM THE SHIP INSURANCE PLAN.

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How to fill out mghihp-termination-request-form

01

Download the MGH IHP Termination Request Form from the official website

02

Fill out the patient information section including name, address, date of birth, and member ID

03

Provide details of the reason for termination in the designated section

04

Sign and date the form

05

Submit the completed form to the appropriate person or department at MGH IHP

Who needs mghihp-termination-request-form?

01

Patients who wish to terminate their membership with MGH IHP

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What is mghihp-termination-request-form?

mghihp-termination-request-form is a form used to request the termination of coverage under the Massachusetts Group Insurance Commission (GIC) Health Insurance program.

Who is required to file mghihp-termination-request-form?

Employees who wish to terminate their coverage under the GIC Health Insurance program are required to file mghihp-termination-request-form.

How to fill out mghihp-termination-request-form?

mghihp-termination-request-form can be filled out online through the GIC website or in person at the GIC office. The form requires basic information such as name, address, date of birth, and reason for termination.

What is the purpose of mghihp-termination-request-form?

The purpose of mghihp-termination-request-form is to officially request the termination of coverage under the GIC Health Insurance program.

What information must be reported on mghihp-termination-request-form?

mghihp-termination-request-form requires information such as name, address, date of birth, reason for termination, and effective date of termination.

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