Get Hmsa Children's Plan

Filling out the Hmsa Children's Plan application online is a straightforward process that ensures your child receives the necessary health coverage. This guide will walk you through each section of the application to make it user-friendly and efficient.

Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to access the application form and open it in the appropriate editor.
2. Fill in the last name, first name (legal), and middle initial of the parent or guardian. Provide relevant phone numbers, including home, work, and cell.
3. List the name of the other parent authorized to receive information about this application, including their last name, first-name (legal), middle initial, and corresponding phone numbers.
4. Enter the mailing address, including the number and street or P.O. Box number, city, state, and ZIP code.
5. If applicable, complete the billing address section if different from the mailing address.
6. Provide your child's present or former HMSA subscriber ID and the name(s) of any other medical carrier(s) if they have other medical coverage.
7. In the child applicant information section, enter the child's last name, first name (legal), middle initial, sex, birth date, and Social Security number.
8. Select a participating primary care provider and health center for your child. Indicate whether they are the current provider by checking 'Yes' or leaving it unchecked.
9. Review the agreement regarding membership and sign the application. Make sure to date it appropriately. If you are a legal guardian, attach copies of relevant guardianship papers.
10. Ensure all sections of the application are completed. You may save your changes, download, print, or share the form as needed.

Complete the HMSA Children's Plan application online today to secure your child's health coverage.