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Page 1 of 82024 Enrollment Request Form o UHC Dual Complete NYS002 (HMOPOS DSNP) H3387014001 BFGInformation about you (Please type or print in black or blue ink) Last nameFirst nameBirth date Home

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How to fill out uhc dual complete ny-s002

01

Obtain UHC Dual Complete NY-S002 form.

02

Fill out personal information including name, address, date of birth, and Member ID.

03

Provide information about your Medicare coverage including effective date, plan type, and enrollment period.

04

Fill out information about your Medicaid coverage including Effective date, plan type, and enrollment period.

05

Review the completed form for accuracy and sign and date where required.

Who needs uhc dual complete ny-s002?

01

Individuals who are eligible for both Medicare and Medicaid benefits in the state of New York.

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What is uhc dual complete ny-s002?

UHC Dual Complete NY-S002 is a specific form related to the UnitedHealthcare Dual Complete plan, which is designed for individuals eligible for both Medicare and Medicaid in New York.

Who is required to file uhc dual complete ny-s002?

Individuals who are enrolled in the UHC Dual Complete plan and need to report their eligibility or changes in circumstances are required to file the UHC Dual Complete NY-S002.

How to fill out uhc dual complete ny-s002?

To fill out UHC Dual Complete NY-S002, carefully read the instructions provided, enter your personal information, report any relevant medical or financial details, and review the form for accuracy before submission.

What is the purpose of uhc dual complete ny-s002?

The purpose of UHC Dual Complete NY-S002 is to communicate necessary changes in eligibility or enrollment status for individuals utilizing both Medicare and Medicaid services.

What information must be reported on uhc dual complete ny-s002?

Information that must be reported includes personal identification details, health insurance coverage information, income data, and any changes in medical or financial situations.

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