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WESTERN MICHIGAN HEALTH INSURANCE POOL (WMHIP) Name of Employer/Plan Sponsor: WMHIP Jenison Public SchoolsGroup # 71565Plan Choice: ___$1,600/$3,200 100% HSA PAK A $40 DRUG CARD ___$1,600/$3,200 100%
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How to fill out wmhip enrollment form 1124
How to fill out wmhip enrollment form 1124
01
Obtain a copy of the wmhip enrollment form 1124.
02
Fill in your personal information such as name, address, phone number, and date of birth.
03
Provide information about your current health insurance coverage, if applicable.
04
Answer all the questions on the form accurately and completely.
05
Sign and date the form before submitting it to the appropriate party.
Who needs wmhip enrollment form 1124?
01
Individuals who are seeking to enroll in the Wisconsin Medicaid Health Insurance Program (WMHIP).
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What is wmhip enrollment form 1124?
WMHIP Enrollment Form 1124 is a form used for enrolling in the Wisconsin Mental Health Integrated Program.
Who is required to file wmhip enrollment form 1124?
Individuals seeking to enroll in the Wisconsin Mental Health Integrated Program must file Form 1124.
How to fill out wmhip enrollment form 1124?
To fill out WMHIP Enrollment Form 1124, you need to provide personal information, including demographics, contact details, and any other required information specified on the form.
What is the purpose of wmhip enrollment form 1124?
The purpose of WMHIP Enrollment Form 1124 is to collect the necessary information to initiate enrollment in the Wisconsin Mental Health Integrated Program.
What information must be reported on wmhip enrollment form 1124?
The form requires information such as personal identification details, demographics, mental health history, and contact information.
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