Get Sc Dhec 1536 2017-2025

The SC DHEC 1536 form is an essential document for individuals seeking assistance with private or commercial insurance coverage through the Insurance Assistance Program. This guide provides a clear and supportive walkthrough of how to accurately complete the form online.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Fill in the applicant information section. Enter the last name, first name, full middle name, date of birth, and Social Security number if available. Make sure to also include the street address, city, state, zip code, and county of residence.
3. Indicate the applicant's gender and provide contact information, including home phone and any other relevant phone numbers.
4. Complete the ethnicity and race sections by selecting the appropriate checkboxes as applicable.
5. In the eligibility information section, list all household members along with their relationship to the enrollee, gender, date of birth, place of employment or source of income, and their estimated yearly gross income. Ensure to provide necessary income documentation.
6. In the certification/consent section, carefully read the consent statements and confirm your understanding by signing and dating the application at the end of this section.
7. Ensure the benefits information, medical insurance, and clinical information sections are filled in as directed. Check the necessary boxes and provide any required attachments.
8. Review the entire form for completeness and accuracy, ensuring all necessary signatures from the physician and case manager are present.
9. Save your changes, and download or print the completed form for your records.
10. Submit the completed form and all required documentation as per the submission guidelines.

Complete your SC DHEC 1536 application online today for timely assistance with your insurance needs.