Long Beach California Affidavit of No Coverage by Another Group Health Plan

State:
Multi-State
City:
Long Beach
Control #:
US-321EM
Format:
Word; 
Rich Text
Instant download

Description

The employee named in this affidavit attests to the fact that he or she is not covered by any other group health plan.

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Long Beach California Affidavit of No Coverage by Another Group Health Plan