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The document is a Late Health Waiver Request form for students at Northeastern University, outlining the necessary information and requirements for waiving the university's health insurance plan. It specifies the criteria that an alternative health insurance plan must meet according to Massachusetts regulations, including coverage details and effective dates. The form requires student information, insurance carrier details, and a signature confirming compliance with the stated requirements.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (81 Votes)
2013	4.4 Satisfied (70 Votes)

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