Get the free Advantage by Buckeye Community Health Plan Enrollment Request Form

This form is used to enroll in the Advantage by Buckeye Community Health Plan. It collects personal information, Medicare insurance details, and payment options while providing information on eligibility

How to fill out advantage by buckeye community

How to fill out Advantage by Buckeye Community Health Plan Enrollment Request Form

1. Obtain the Advantage by Buckeye Community Health Plan Enrollment Request Form from the official website or local office.
2. Fill out personal information including name, address, date of birth, and contact details.
3. Provide any required identification numbers, such as Social Security Number or Medicaid number.
4. Select the type of coverage you are applying for, ensuring you meet the eligibility criteria.
5. Complete any additional sections that apply, such as plan choices or special needs information.
6. Review the form for accuracy and completeness before submission.
7. Sign and date the form at the designated areas.
8. Submit the completed form via mail, fax, or in-person as instructed on the form.

Who needs Advantage by Buckeye Community Health Plan Enrollment Request Form?

1. Individuals seeking healthcare coverage through the Advantage by Buckeye Community Health Plan.
2. Eligible low-income families or individuals needing assistance with medical expenses.
3. Residents who qualify for Medicare or Medicaid services.
4. Anyone looking for information on managed care options in their area.

People Also Ask about

How do I verify eligibility for Buckeye Health Plan?

Providers are responsible for verifying eligibility every time a member is seen in the office. PCPs should also verify that a member is assigned to them. To verify enrollment call Buckeye Provider Services at 1-866-296-8731 or log on to Buckeye's Secure Provider Portal .

How do I verify eligibility for Buckeye Health Plan?

Providers are responsible for verifying eligibility every time a member is seen in the office. PCPs should also verify that a member is assigned to them. To verify enrollment call Buckeye Provider Services at 1-866-296-8731 or log on to Buckeye's Secure Provider Portal .

How to apply for free healthcare in Ohio?

Apply online using the self-service Ohio Benefits Portal, by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or by visiting your local Department of Job and Family Services (JFS) office.

Is Buckeye Health Plan a Medicaid plan?

Buckeye Health Plan is a health plan provider offering Ohio Medicaid benefits for eligible members in all 88 counties or throughout the state. Our extensive network of local providers allows us to connect you with providers and services you need in your area.

How do I apply for Medicaid in Buckeye Ohio?

How to Apply ONLINE: Go to the Ohio Benefits website — this is the fastest way! PHONE: Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680. IN PERSON: Visit your County Department of Job and Family Services office. Find your county office at the JFS website.

How do I apply for Buckeye Health Plan?

- this is the fastest way! at 1-800-324-8680. IN PERSON: Visit your County Department of Job and Family Services office. You can find your county office here .

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What is Advantage by Buckeye Community Health Plan Enrollment Request Form?

The Advantage by Buckeye Community Health Plan Enrollment Request Form is a document used to enroll individuals in the Advantage health plan offered by Buckeye Community Health Plan, which provides healthcare coverage and services.

Who is required to file Advantage by Buckeye Community Health Plan Enrollment Request Form?

Individuals seeking to enroll in the Advantage by Buckeye Community Health Plan are required to file the Enrollment Request Form.

How to fill out Advantage by Buckeye Community Health Plan Enrollment Request Form?

To fill out the Enrollment Request Form, individuals should provide personal information, such as their name, address, date of birth, and any relevant health insurance information, and ensure all sections of the form are completed accurately.

What is the purpose of Advantage by Buckeye Community Health Plan Enrollment Request Form?

The purpose of the Enrollment Request Form is to facilitate the enrollment process for individuals who wish to receive healthcare services under the Advantage by Buckeye Community Health Plan.

What information must be reported on Advantage by Buckeye Community Health Plan Enrollment Request Form?

The information that must be reported includes personal identification details (name, address, date of birth), contact information, and any current health insurance details, as well as any additional required health-related information.