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COMMONWEALTH OF PENNSYLVANIA OFFICE OF LONGTERM LIVING SERVICE PROVIDER CHOICE FORM Participant Name (Last, First, Middle): Participant ID Number: Before you choose who will be providing your home.

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Use this form to join or change health plans. If you need help filling out this form, call 1-800-430-4263. Mail Completed form to: California Department of Health Care Services • Health Care Options • Box 989009, W. Sacramento, CA 95798-9850.

Yes. If you are in a Medi-Cal health plan and want to choose another health plan for any reason, you may leave the health plan and join a different health plan. You can call Health Care Options (HCO), toll free, at 1-800-430-4263 (TTY 1-800-430-7077), 8 a.m. to 6 p.m. PT, Monday through Friday, except holidays.

You should keep this guide and use it when you have questions about Medi-Cal. California offers two ways to get health coverage. They are “Medi-Cal” and “Covered California.” Both programs use the same application.

To join a medical plan, call Health Care Options at 1-800-430-4263. Or you can complete a Medi-Cal Choice Form. You can find the form on the Download forms page. You can use your Medi-Cal Benefits Identification Card (BIC) for services through Regular (Fee-for-Service) Medi-Cal until you are a medical plan member.

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.

Use this form to join or change a health plan. For FREE help with this form, contact Health Care Options at 1-844-580-7272. Mail completed form to California Department of Health Care Services, Health Care Options, P.O. Box 989009, West Sacramento, CA 95798-9850.

Most people who have Medi-Cal must enroll in a medical plan. You or a member of your family must choose a medical plan if: You get CalWorks benefits (cash aid, food stamps) You get Medi-Cal only and you do not have a share of cost.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232