Get the free Medi-Cal Choice Form for San Diego County
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Mail form back to: California Department of Health Care Services
P.O. Box 989009 W. Sacramento, CA 957989850
Use this form to join or change plans. For help, call 18004304263.
To indicate your choice.
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How to fill out medi-cal choice form for
How to fill out medi-cal choice form for
01
Obtain a copy of the medi-cal choice form from the Medi-Cal office or website.
02
Fill out your personal information, including name, address, date of birth, and social security number.
03
Provide information about your household income and size to determine eligibility.
04
Include details about any other insurance coverage you may have.
05
Sign and date the form before submitting it to the appropriate Medi-Cal office.
Who needs medi-cal choice form for?
01
Individuals who are seeking to apply for or renew their eligibility for Medi-Cal benefits.
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What is medi-cal choice form for?
The Medi-Cal choice form is used by individuals to indicate their preference for a managed care plan under the Medi-Cal program in California.
Who is required to file medi-cal choice form for?
Individuals who are eligible for Medi-Cal and wish to enroll in a managed care plan are required to file the Medi-Cal choice form.
How to fill out medi-cal choice form for?
To fill out the Medi-Cal choice form, applicants need to provide personal information, select a preferred managed care plan, and submit the form according to the provided instructions.
What is the purpose of medi-cal choice form for?
The purpose of the Medi-Cal choice form is to allow beneficiaries to select their desired healthcare plan and ensure they receive the appropriate services.
What information must be reported on medi-cal choice form for?
The information that must be reported on the Medi-Cal choice form includes the applicant's personal details, Medi-Cal identification number, and selected managed care plan.
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