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Get UT Altius Small Employer Waiver Form 2006-2024

Oyer: ________________________________________________ WAIVER INFORMATION I understand that I am eligible to participate in the group health plan offered through my employer and have been given the opportunity to do so. I DO NOT want coverage. I am declining coverage at this time due to the following: o I currently have coverage elsewhere o Covered by Medicaid o Covered by Medicare o Individual policy o Group continuation coverage (COBRA) o Other CURRENT HEALTH INSURANCE INFORMATION (This sec.

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