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P.O. Box 2156 Pohnpei, FSM 96941 Email: info@micareplan.fmLASTFIRSTMIINSURANCE ID NUMBERCurrent Mailing Address Phone NumbersHome:Cell:Work:Email:Requesting with MiCare office to make the following amendments to my enrollment including my dependents in the MiCare Health Insurance Plan: A.CHANGE PLAN OPTION NAME OF DEPENDENTCURRENT PLANNEW PLANRESIDENCYB. ADD DEPENDENT(s) *1. Indicate Yes or No if added Dependent is new to MiCare 2. Indicate Yes or No if added Dependent
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What is micare-amendment-formpdf?
The micare-amendment-formpdf is a specific form related to the amendments in the Managed Care Services regulations, used for reporting changes in managed care organization information.
Who is required to file micare-amendment-formpdf?
Managed care organizations and providers who make amendments to their previously submitted information are required to file the micare-amendment-formpdf.
How to fill out micare-amendment-formpdf?
To fill out the micare-amendment-formpdf, one must complete all required sections with accurate information regarding the amendments being made and submit it following the specified guidelines.
What is the purpose of micare-amendment-formpdf?
The purpose of the micare-amendment-formpdf is to formally document and report amendments to managed care organization information to ensure compliance with regulatory requirements.
What information must be reported on micare-amendment-formpdf?
The micare-amendment-formpdf must report information including the nature of the amendments, affected services, organization details, and any other relevant changes that impact managed care services.
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