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Get CT CCCEN 2010-2024

Ame of Qualified Beneficiary(ies) This notice contains important information about your right to continue your health care coverage in the ______________________________________________________________________ (the Plan). (Name of Group Health Plan) Please read the information contained in this notice very carefully. To elect continuation coverage, follow the instructions on the following pages to complete the enclosed Election Form and submit it to us. If you do not elect continuation coverag.

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