RsGR67466-2 doc 2025

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The document is an application form for Aetna Health Inc.'s New York Individual Advantage plan. It outlines the process for enrollment, coverage effective dates based on payment timing, and requirements for providing personal and dependent information. The form includes sections for subscriber details, dependent information, reasons for changes in coverage, and acknowledgment of pre-existing condition exclusions. It emphasizes the importance of timely premium payments and the necessity of using participating healthcare providers.

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