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Large Group Employee and Individual Application and Enrollment Form The offering company(ies) listed below, severally or collectively, as the content may require, are referred to in the Large Group Employee and Individual Application and

Large Group Employee and Individual Application and Enrollment Form The offering company(ies) listed below, severally or collectively, as the content may require, are referred to in the Large Group Employee and Individual Application and 2025

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4.4 out of 5

71 votes

The document is a Large Group Employee and Individual Application and Enrollment Form for Humana, detailing the process for enrolling in various insurance plans including medical, dental, vision, life, and disability coverage. It includes sections for personal information, dependent details, coverage selections, health status evidence, waivers of coverage, and authorizations for medical records. The form aims to collect necessary data to determine eligibility and facilitate enrollment in the offered insurance products.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (143 Votes)
2014	4.4 Satisfied (71 Votes)

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