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Filling out the Health Coverage Mail/Fax Cover Sheet accurately is a crucial step in ensuring that your health coverage documents are processed efficiently. This guide provides clear instructions on completing each section of the form online, ensuring you can submit your information correctly.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the document and open it in your preferred online editor.
2. Begin by entering the last four digits of the head of household’s Social Security Number or their initials along with their date of birth in the specified fields.
3. Proceed to the 'Sender' section. Clearly print your name, Social Security Number, phone number, and date of birth in the designated spaces.
4. If applicable, provide the MassHealth ID Number, name of the facility, and reference ID number in their respective fields.
5. In the 'Applicant/Member' field, provide the name of the individual applying for health coverage.
6. Indicate the total number of pages you are submitting, including both cover sheets, to ensure all documents are accounted for.
7. Review all entered information for accuracy to prevent delays in processing. Once confirmed, you can save your changes.
8. After filling out the form, you can download, print, or share the completed document as needed to send it to the relevant health coverage offices.

Complete your documents online today for a smoother submission process.