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Health Insurance Registration
Register for state health insurance coverage
Application Fee:
Free |
Processing Time:
10-14 business days
Personal Information
First Name *
Last Name *
Date of Birth *
Gender *
Select gender
National ID Number *
Phone Number *
Email Address
Residential Address *
Employment Status *
Select employment status
Medical History (Optional)
Required Documents
National ID or Passport *
Passport Photo *
Medical Records (if available)
Submit Registration
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