This government document is issued by California Health Benefit Exchange for use in California
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https://www.google.com/url?client=internal-element-cse&cx=009854164935538441977:yzlo2be1knm&q=http://hbex.coveredca.com/tribal-consultation/PDFs/Tribal%2520Premium%2520Sponsorship%2520Interest%2520Form.pdf&sa=U&ved=2ahUKEwiEsaSVrqPyAhUMt4sKHdJIAP04HhAWMAZ6BAgEEAI&usg=AOvVaw0ANVSDuZYyVlVBF2NvyqKC