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APPLICATION FOR SOUTH DAKOTA RISK POOL HEALTH COVERAGE Please mail the completed application all necessary documentation and applicable premium to South Dakota Risk Pool c/o Bureau of Personnel 500 East Capitol Avenue Pierre SD 57501 or fax to 605. 773. 6840 For questions call 605. 773. 3148 and ask for a Risk Pool representative. Failure to completely answer all questions and to submit required documentation may delay the processing of your application* 1. Applicant Information Last Name...

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