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OMB No. 09381378 Expires: 7/31/2024 INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) Who can use this form? Reminders: People with Medicare who want to join a plan

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How to fill out simply healthcare

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Gather all necessary information such as personal details, income information, and family size.

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Visit the Simply Healthcare website or contact their customer service to start the application process.

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Fill out the application form with accurate information and double check for any errors.

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Submit the completed application online or through mail as per the instructions provided.

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Who needs simply healthcare?

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Simply Healthcare is designed for individuals and families who are looking for affordable health insurance coverage.

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It is also beneficial for individuals who may not qualify for Medicaid but still need access to healthcare services.

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What is simply healthcare?

Simply healthcare is a simplified health insurance plan that offers basic coverage for medical expenses.

Who is required to file simply healthcare?

Individuals who are eligible for the plan and wish to obtain health insurance coverage must file simply healthcare.

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The purpose of simply healthcare is to provide individuals with an affordable and basic health insurance option to cover medical expenses.

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Basic personal information, income details, and health insurance preferences must be reported on simply healthcare.

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