Get Passport Health Plan Kchip Application Assistance Form

This guide provides step-by-step instructions on how to fill out the Passport Health Plan KCHIP Application Assistance Form online. By following these directions, users can ensure that their application is completed accurately and efficiently.

Follow the steps to complete your application online:

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by filling in the referral information. Enter the name of the facility or provider that referred you and the date of referral.
3. Next, provide the address of the facility where assistance was sought.
4. In the applicant information section, list the name of the child or children for whom you are applying.
5. Fill in the ages and date(s) of birth for each child listed.
6. Provide the name of the parent or guardian responsible for the application.
7. Complete the address information, including street address, city, state, and zip code.
8. Indicate the family’s preferred language for communication.
9. Enter a contact phone number where you can be reached.
10. Choose the best time to contact you, selecting either mornings or evenings.
11. Indicate whether the child or children currently have health insurance by circling 'yes' or 'no'.
12. Circle 'yes' or 'no' to confirm if the child or children have been Passport Health Plan members in the past.
13. Circle 'yes' or 'no' to indicate if the child or children are U.S. citizens.
14. Lastly, note how many children in the household are under the age of 19.
15. Once you have completed all sections, review your answers for accuracy.
16. Save your changes, and then download, print, or share the form as needed.

Complete your application online today to ensure your children's health coverage!