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HA08891020State Health Benefits Program (SHIP)LOCAL GOVERNMENT ACTIVE EMPLOYEE GROUPHEALTH BENEFITS ENROLLMENT AND/OR CHANGE FORM1. MEMBER INFORMATION Last NameFirstMIDIVISION USE ONLY Effective Dates
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Start by obtaining the ha0889 state health benefits form.
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Carefully read through the instructions on the form.
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Fill in your personal information, including your name, address, and contact details.
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Provide details about your current health insurance coverage, if applicable.
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Indicate your marital status and dependent information, if applicable.
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Who needs ha0889 state health benefits?

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The ha0889 state health benefits are typically needed by individuals or families who are eligible for state-sponsored health insurance programs.
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This may include low-income individuals, individuals with disabilities, children, pregnant women, or individuals experiencing a temporary loss of employer-based coverage.
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Eligibility requirements may vary depending on the specific state health benefits program.
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HA0889 state health benefits refer to a specific form or program related to health benefits provided by a state. It typically involves reporting or claiming eligibility for state-sponsored health insurance or assistance.
Individuals who are applying for state health benefits or those required to report eligibility changes, income, or other relevant information concerning their health benefits are required to file HA0889.
To fill out HA0889, you need to complete the form with accurate personal information, including your name, address, income details, and any other requested information. It's essential to follow the instructions provided with the form carefully.
The purpose of HA0889 state health benefits is to determine eligibility for state health programs and assistance, ensuring that individuals receive the help they need in accessing healthcare services.
Information required on HA0889 includes personal identification details, household income, family size, medical history, and any changes in circumstances that may affect eligibility for health benefits.
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