Get the free U1134 MSHO Enrollment Form.pdf - UCare - ucare
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U Care s Minnesota Senior Health Options Care s MHO (HMO SNP) Enrollment Form Care s MHO Sales: 612-676-3554 or 1-800-707-1711 (toll-free) TTY for the hearing impaired at 612-676-6810 or 1-800-688-2534
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How to fill out u1134 msho enrollment formpdf
How to fill out u1134 msho enrollment formpdf?
01
Start by downloading the u1134 msho enrollment formpdf from the official website or platform.
02
Open the downloaded file using a PDF reader on your computer or mobile device.
03
Begin filling out the form by entering the required personal information, such as your full name, date of birth, and contact details.
04
Provide your current address, including the street name, city, state, and zip code.
05
Indicate your preferred language for communication and any special accommodations required.
06
Specify your Medicare number, if applicable, along with the effective date of your Medicare Part A and Part B.
07
If you have any other health insurance coverage, indicate the type and provide the policy number.
08
Answer the questions regarding your eligibility for the program, including any additional coverage options you may have.
09
Sign and date the form to confirm that the information provided is accurate to the best of your knowledge.
Who needs u1134 msho enrollment formpdf?
01
Individuals who are eligible for the Minnesota Senior Health Options (MSHO) program need to fill out the u1134 msho enrollment formpdf.
02
MSHO is a joint program that combines Medicare and Medical Assistance benefits for qualifying individuals in Minnesota.
03
This form is required for individuals who wish to enroll or make changes to their MSHO coverage, ensuring that they receive the necessary healthcare services.
04
Before filling out the form, it is important to determine if you meet the eligibility criteria for the MSHO program, which primarily includes seniors aged 65 and above who qualify for Medical Assistance.
05
If you believe you meet the eligibility requirements for MSHO, you should complete the u1134 msho enrollment formpdf to begin the enrollment process and access the benefits offered by the program.
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