Get the free Use this form to enroll in University of Michigan Health Plan

OMB No. 09381378 Expires: 6/30/20262025 Enrollment Request FormUse this form to enroll in University of Michigan Health PlanWho can use this form?People with Medicare who want to join a Medicare Advantage

How to fill out use this form to

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1. Obtain the form from the appropriate source.
2. Read the instructions carefully to understand the required information.
3. Begin by filling out your personal details such as name, address, and contact information.
4. Provide any necessary identification numbers if required.
5. Fill in the sections related to the purpose of the form, ensuring all information is accurate.
6. Review all entered information for correctness and completeness.
7. Sign and date the form as required.
8. Submit the form according to the given instructions, whether online or by mail.

Who needs use this form to?

1. Individuals seeking to apply for a service or program.
2. Businesses needing to register or provide information to a government entity.
3. Participants required to enroll in a specific program or activity.
4. Anyone required to report information to a regulatory body.

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This form is used to report specific financial or tax-related information to the relevant authorities.

Who is required to file use this form to?

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