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Page 1 of 82024 Enrollment Request Form o UHC Dual Complete WIV001 (HMOPOS DSNP) H3794004000 BNCInformation 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 wi-v001

01

Obtain the UHC Dual Complete WI-V001 form from your healthcare provider or insurance company.

02

Start by entering your personal information such as your name, address, date of birth, and insurance policy number.

03

Fill out the sections related to your medical history, current medications, and any additional coverage you may have.

04

Review the completed form for accuracy and make any necessary corrections before submitting it.

05

Submit the filled-out UHC Dual Complete WI-V001 form to your insurance company or healthcare provider as instructed.

Who needs uhc dual complete wi-v001?

01

Individuals who are eligible for the UHC Dual Complete WI-V001 plan

02

Those who are seeking comprehensive healthcare coverage through United Healthcare

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What is uhc dual complete wi-v001?

UHC Dual Complete WI-V001 is a healthcare enrollment form used by individuals who are eligible for both Medicare and Medicaid. It helps facilitate the enrollment process in dual special needs plans.

Who is required to file uhc dual complete wi-v001?

Individuals who are eligible for both Medicare and Medicaid and wish to enroll in a dual special needs plan are required to file the UHC Dual Complete WI-V001.

How to fill out uhc dual complete wi-v001?

To fill out the UHC Dual Complete WI-V001, individuals need to provide personal information such as name, address, Medicare number, Medicaid number, and details about their healthcare preferences. It is advisable to follow the instructions provided with the form carefully.

What is the purpose of uhc dual complete wi-v001?

The purpose of the UHC Dual Complete WI-V001 is to allow eligible individuals to enroll in health plans that provide coordinated care for those who qualify for both Medicare and Medicaid.

What information must be reported on uhc dual complete wi-v001?

The UHC Dual Complete WI-V001 requires reporting personal identification details, Medicare and Medicaid numbers, as well as information about healthcare providers and preferences for care.

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