Get Application For Healthy Indiana Plan - Mdwise - Mdwise

This guide provides clear and supportive instructions for completing the Application For Healthy Indiana Plan - MDwise - Mdwise online. By following these steps, you will ensure that your application is filled out accurately and completely.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application and open it for completion.
2. Begin with Section 1, where you will select your health plan. Mark the box next to your preferred plan: Anthem Blue Cross Blue Shield, MHS, or MDwise. If you wish to receive a paper provider directory, indicate yes or no.
3. Proceed to Section 2. Here, provide details about adult household members, such as name, date of birth, and Social Security number. Select their marital status and indicate if they are applying for HIP.
4. In Section 3, enter the total number of household members living in your home.
5. Section 4 requires your address and contact information, including home and alternative telephone numbers and an email address.
6. For Section 5, list children in your household, including their names, dates of birth, Social Security numbers, and relationships with the applicants. Indicate if anyone is a caregiver.
7. In Section 6, confirm if all applicants reside in Indiana by checking yes or no.
8. Complete Section 7 if applicable, detailing any out-of-pocket expenses paid for care received by a dependent in your household.
9. Section 8 is for immigration status if applicable. Provide necessary details regarding lawful residency or other statuses.
10. In Section 9, answer health and insurance-related questions for each applicant, including disabilities, pregnancy status, and reasons for any loss of health insurance.
11. Section 10 requires you to document work income for each applicant, including employer details and payment frequency.
12. In Section 11, list any additional sources of income your household may receive and answer the income initial prompt if appropriate.
13. Complete Section 12 by responding to health screening questions, providing either a 'Yes' or 'No' for each applicant.
14. Sign and date the application in Section 13, ensuring that all fields are completed accurately.
15. Finally, review your application for completeness and accuracy. Save any changes, and choose to download, print, or share your application as needed.

Complete your application for the Healthy Indiana Plan online to ensure timely processing and eligibility.