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Policyholder Last Name Field Instructions
Policyholder Last Name |
Conditional, alphanumeric, 25 positions maximum If the Other Insurance field is Y, enter the last name of the individual who holds the policy from another group health insurance program under which the enrollee or family member is covered. If the policyholder has a title (e.g., Jr, Sr, I, II, or III), it should be entered after the last name without punctuation (e.g., Smith Jr or Smith III). If the Other Insurance field is N, do not complete this field. |