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REQUEST FOR INFORMATION (Complete one form per family) Please answer the question below by checking the appropriate box. The following information is a request adopted by the General Assembly in 2010
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How to fill out missouri health net
Who needs Missouri Health Net?
01
Residents of Missouri who meet the income eligibility requirements and do not have access to employer-sponsored health insurance or other government health coverage.
02
Individuals who are pregnant, parents or caretaker relatives of dependent children, or adults with a disability.
03
Those who are seeking affordable health coverage options and want to access medical, dental, and vision care services.
How to fill out Missouri Health Net:
01
Visit the official website of Missouri Health Net or contact the local Division of Family Services office to obtain the necessary application forms.
02
Provide personal information such as your full name, date of birth, social security number, address, and contact details.
03
Indicate your household members, including their names, ages, and relationship to you.
04
Provide information about your income, including any wages, benefits, or other sources that contribute to your household's total income.
05
Declare any assets you own, such as vehicles, property, or savings accounts.
06
If applicable, provide details about your current health coverage or insurance plans.
07
Sign and date the application form, ensuring that all required fields are completed accurately.
08
Attach any necessary supporting documents, such as proof of income or residency, to validate the information provided in the application.
09
Submit the completed application either by mailing it to the designated address or by visiting a local Division of Family Services office in person.
10
Wait for a notification from Missouri Health Net regarding the status of your application, which will inform you if you have been approved for coverage and provide you with your health net benefits.
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