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Employer Authorization Form

This letter will serve as your company's authorization to release to Discovery Benefits all information necessary for its use in providing COBRA administrative services to our company.

This information includes, but is not limited to, employee names, social security numbers, addresses, dependents' names, social security numbers, addresses, types and levels of coverage provided by your organization, cost of this coverage, effective date of coverage and payment status.

Form Type: Administrative
Categories: COBRA

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