Get Aspire-member Qualification Form - Detroitk12

Filling out the Aspire-Member Qualification Form is an important step to ensure you meet the requirements for the Enhanced plan coverage. This guide will provide clear, step-by-step instructions on how to complete the form online effectively.

Follow the steps to complete the Aspire-Member Qualification Form seamlessly.

1. Click ‘Get Form’ button to access the Aspire-Member Qualification Form. Once you have clicked the button, the form will open in your selected editor.
2. Begin by filling out Section 1, which includes your member information. Provide your full name, member ID number, date of birth, personal care physician's name, due date, and their NPI number.
3. Proceed to Section 2, where you will enter health and lifestyle information. For each lifestyle behavior, complete the necessary measurements, such as height and weight, and answer the questions regarding preventive services and tobacco/nicotine use.
4. Complete additional fields as required, selecting the appropriate options for each wellness target and status, ensuring all sections are addressed. Check that you have provided accurate and honest information regarding lifestyle choices.
5. In Section 3, gather your provider's information. They must review and sign the form, confirming all details are complete and accurate. Enter your provider's name, phone number, signature, date, and NPI number.
6. After finalizing all sections, review the entire form for accuracy. Ensure that you have filled in all fields, as incomplete submissions will not be accepted.
7. Save your changes, and select the option to download or print the form for your records. You may also share the completed form according to submission guidelines.

Complete your Aspire-Member Qualification Form online today to ensure you meet the necessary requirements.