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WESTERN MICHIGAN HEALTH INSURANCE POOL (WHIP)
Name of Employer/Plan Sponsor:
WHIP Jenison Public SchoolsGroup #
71565Plan Choice:
___$1,500/$3,000 100% HSA PAK A $40 DRUG CARD
___$1,500/$3,000 100%
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How to fill out wmhip enrollment form 1123
How to fill out wmhip enrollment form 1123
01
Obtain a copy of the WMHIP enrollment form 1123.
02
Fill out the personal information section including name, contact information, and date of birth.
03
Provide information on your current health insurance coverage, if applicable.
04
Fill out the section on Medicare and Medicaid eligibility.
05
Sign and date the form before submitting it.
Who needs wmhip enrollment form 1123?
01
Individuals who are applying for the WMHIP program and need to provide their personal and insurance information.
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What is wmhip enrollment form 1123?
The wmhip enrollment form 1123 is a form used to enroll in the Wisconsin Medicaid Health Insurance Program (wmhip).
Who is required to file wmhip enrollment form 1123?
Individuals who meet the eligibility criteria for the Wisconsin Medicaid Health Insurance Program are required to file wmhip enrollment form 1123.
How to fill out wmhip enrollment form 1123?
To fill out the wmhip enrollment form 1123, individuals must provide accurate and complete information about their personal details, income, and household members.
What is the purpose of wmhip enrollment form 1123?
The purpose of wmhip enrollment form 1123 is to collect necessary information for enrollment in the Wisconsin Medicaid Health Insurance Program.
What information must be reported on wmhip enrollment form 1123?
Information such as personal details, income, and household members must be reported on wmhip enrollment form 1123.
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