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Get CalPERS HBD-12A 2015-2024

Ng yourself only, your dependents have other health insurance coverage, or b) Canceling your dependents’ coverage because they have other health insurance coverage Part B-2: Mark this box if you are: a ) Enrolling yourself and SOME of your dependents, your other dependents have health insurance coverage, or b) Canceling coverage for some of your dependents because they have other health insurance coverage. Part C-1: Mark this box if you are: a) Declining enrollment or canceling your health.

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