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Get Health Plan Administrators, Inc. 2008 Overseas Travel Medical List Bill

Of an employer-sponsored health insurance program for the purpose of Section 162, Section 125 or Section 106 of the United States Internal Revenue Code. Complete the following for a monthly list billing. Please attach the Individual Applications, a Temporary Insurance Acknowledgement Form signed by each applicant participating in the list billing, and a check for the first month s premiums / fees due. List the requested effective date here (The same day of the month will apply to all applican.

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