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Request for Member Disenrollment Use of this form is restricted to MHS members only. Use a separate form for each family. OB reassignment Include the member s delivery date. The member s has been notified of the request for disenrollment Yes Include a copy of the letter sent to the member advising them of the diserollment request. No Fax completed form to MHS Member Services 866 912-1629 1210. MS.P. FO. 4 7/09 Managed Health Services 1099 N. Me.

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See below if your 2024 income qualifies. Individuals with annual incomes up to $20,793 may qualify. Couples with annual incomes up to $28,214.40 may qualify. A family of four with an annual income of $43,056 may qualify.

It's important to tell your state caseworker of any changes in your income or family (marriage, head of household changes, etc.). You can call 1-800-403-0864. Or, you can visit your local Division of Family Resources (DFR) office to report a change.

On an annual basis, HIP members have the opportunity to switch to another health plan for the following year. A member wishing to change health plans may do so by calling 877-GET-HIP-9 between November 1 and December 15. All changes will be effective January 1 and stay in effect for the next calendar year.

We provide healthcare that fits your needs, at a price that fits your budget. All of our plans include quality, comprehensive coverage with a provider network you can trust. MHS is your choice for affordable health insurance. Claims must be received within 90 calendar days of the date of service. Welcome to Managed Health Services (MHS) - MHS Indiana mhsindiana.com https://.mhsindiana.com › centene › medicaid › pdfs mhsindiana.com https://.mhsindiana.com › centene › medicaid › pdfs

You have health coverage through the Healthy Indiana Plan Calling or faxing information to: 800-403-0864. Mailing information to: PO Box 1810, Marion, IN 46952. Submitting a change request through the FSSA Benefits portal: .dfrbenefits.in.gov. FSSA: HIP: Transferring to or from Other Health Coverage - IN.gov in.gov https://.in.gov › fssa › transferring-to-or-from-other... in.gov https://.in.gov › fssa › transferring-to-or-from-other...

The initial plan selection for all members is HIP Plus which offers the best value for members. HIP Plus has comprehensive benefits including vision, dental and chiropractic. The member pays an affordable monthly POWER account contribution based on income.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232