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Enrollment Request Form Illinois and Western Indiana HMO and POS Plans January 1, 2018, December 31, 20182018 Toll free 18883829771 TTY 711 HealthAllianceMedicare.org medIL2018enrlmtfrm0417 H1463
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Illinois and Western Indiana refers to a specific region that includes parts of Illinois and Indiana.
Any individual or entity operating within the Illinois and Western Indiana region may be required to file.
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The purpose of Illinois and Western Indiana filings may vary, but it is typically to report certain information related to business operations in the region.
The specific information that must be reported on Illinois and Western Indiana forms will depend on the requirements set forth by the relevant authorities.
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