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Samaritan Advantage Health Plan (HMO)2017 INDIVIDUAL ENROLLMENT REQUEST FORM MAIL TO: Samaritan Advantage Health Plan (HMO) P.O. Box M, Corvallis OR 97339 DROP OFF: Samaritan Health Plans, 2300 NW

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How to fill out 2017 individual enrollment request

01

Step 1: Gather all the necessary documents and information, such as your personal identification, proof of address, and income verification.

02

Step 2: Visit the official website of the organization or agency handling the enrollment process for 2017 individual enrollment request.

03

Step 3: Fill out the required personal information, including your name, date of birth, and contact details.

04

Step 4: Provide the requested information regarding your income, employment, and household size.

05

Step 5: Review and double-check all the information you have entered to ensure its accuracy and completeness.

06

Step 6: Submit the filled-out enrollment request form through the prescribed method stated on the website or instructed by the organization.

07

Step 7: Wait for the confirmation or notification of your enrollment status. Keep a copy of the submission for future reference.

Who needs 2017 individual enrollment request?

01

Individuals who are seeking to enroll in a specific program or service for the year 2017.

02

People who meet the eligibility criteria set by the organization or agency providing the enrollment request form.

03

Those who want to access benefits, services, or programs that require an individual enrollment request for the year 2017.

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