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ADVANTAGE (HMO SNP)H9870_ADVG001535V2_COMB No. 09381378 Expires:7/31/2023EXHIBIT 1: MODEL INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) OR MEDICARE PRESCRIPTION
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Online HAP Empowered Duals is a platform designed to empower individuals with dual Medicare and Medicaid coverage.
Individuals who have dual eligibility for Medicare and Medicaid are required to file online HAP Empowered Duals.
To fill out online HAP Empowered Duals, individuals need to provide information about their Medicare and Medicaid coverage, as well as other relevant details as requested on the platform.
The purpose of online HAP Empowered Duals is to streamline and improve the coordination of care for individuals with dual Medicare and Medicaid coverage.
Information such as Medicare and Medicaid coverage details, healthcare providers, medications, and other relevant health information must be reported on online HAP Empowered Duals.
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