13197_WHA-SmallGroup-EOC-PROOF

COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM 2349 Gateway Oaks Drive, Suite 100 Sacramento, California 95833 916.563.2250 888.563.2250 toll-free 888.877.5378 tty 916.563.3182 fax 2349 Gateway Oaks Drive, Suite 100 Sacramento, California 95833 916.563.2250 888.563.2250 toll-free 888.877.5378 tty 916.563.3182 fax 2349 Gateway Oaks Drive, Suite 100 Sacramento, California 95833 91 .563.2250 88.563.2250 toll-free 8.877.5378 tty 916.563.3182 fax

PUBLISHED JANUARY 2018 WHA 303 1.18 PUBLISHED JANUARY 2018 WHA 303 1.18 PUBLISHED JANUARY 2018 WHA 303 1.18

| 2018 SMALL GROUP

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