Get Micare Fsm

Completing the Micare Fsm form accurately is essential for enrollment in the MiCare Plan. This guide provides a clear and step-by-step approach to help users navigate the online form efficiently.

Follow the steps to complete your Micare Fsm enrollment application.

1. Press the ‘Get Form’ button to access the enrollment application and open it in your preferred online editor.
2. Carefully fill out your family name, first name, middle initial, age, and birthdate in the designated fields.
3. Indicate your sex by selecting the appropriate option: male or female.
4. Select your civil status from the options provided: single, married, widower, or separated.
5. Enter your height in feet and inches as well as your weight in the specified fields.
6. Provide your home address and telephone number. Be sure to include your business address, telephone number, and fax number, if applicable.
7. Fill out your citizenship status and specify any additional relevant information as required.
8. Include your social security number and residency information in the provided fields.
9. Select your insurance options from the choices available, such as basic, supplemental resident, supplemental non-resident, or non-referral.
10. List your family members, including their residency, options, sex, relationship to you, and birthdates in the designated table.
11. Review and agree to the statement regarding adherence to the MiCare Plan provisions by signing and dating the enrollment form.
12. Authorize payroll deduction by signing in the appropriate section, permitting your employer to deduct contributions from your compensation.
13. Finally, save your changes, download a copy for your records, and consider printing or sharing your completed form as necessary.

Complete your Micare Fsm enrollment application online now for a smoother application process.