Get Dhs-2841a-eng - Dhs State Mn

Filling out the DHS-2841A-ENG form online can streamline the process of determining cost-effective insurance referrals. This guide provides a step-by-step approach to ensure the accurate completion of the form.

Follow the steps to successfully complete the DHS-2841A-ENG form.

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Enter the client name in the designated field, including their last name, first name, and middle initial.
3. Input the client case number accurately in the provided section.
4. Record the date of completion in the format requested by the form.
5. For each person eligible for Medical Assistance (MA) who is not covered by the policy, complete the chart by filling in the first name, age, capitation, prorated monthly premium, and prorated monthly deductible.
6. Calculate the totals for the chart and compare the total capitation with the total prorated premium and deductible to make a cost-effective decision.
7. If everyone covered by the policy is on Medical Assistance, use the second chart to determine cost-effective premiums, entering the total capitation, monthly premium, and prorated deductible.
8. Finalize your decision based on the totals calculated in the charts, and approach further steps if needed as indicated.
9. Review all entries for accuracy before proceeding to save your changes.
10. Once completed, you can download, print, or share the filled-out form as needed.

Complete your DHS-2841A-ENG form online today to ensure an efficient submission process.