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Send completed form, required documentation, and premium payment to: Academic Healthline, Inc. PO Box 1605 Coffeyville, TX 760341605 Enrollment by Qualifying Event This form must accompany the Academic
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How to fill out improper documentation will result:

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Carefully review the provided instructions: It is important to read and understand the guidelines given for filling out the documentation. This will help you avoid any mistakes or omissions that can result in improper documentation.
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Improper documentation will result in delays, errors, and potential legal issues.
All individuals or entities responsible for documenting information are required to file improper documentation.
To fill out improper documentation properly, ensure that all information is accurate, up to date, and correctly formatted.
The purpose of improper documentation is to ensure that information is documented correctly and can be easily accessed or referenced when needed.
All relevant information related to the topic being documented must be reported on improper documentation.
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