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Get MA HC-CS 2020-2024

O. Box 4405 Taunton MA 02780 NEW Fax 857-323-8300 through the Health Connector Closed Enrollment verification for Health Unsubsidized applications and verifications for IDP and Closed Enrollment should be sent to Massachusetts Health Connector 133 Portland Street 1st Floor Boston MA 02114-1707 Fax 617-887-8745 MassHealth long-term-care applications and Supplement A Buy-In applications These applications should be sent to Central Processing Unit P. Health Coverage Mail/Fax Cover Sheet Last four digits of Head of Household s Social Security Number OR Head of Household initials and DOB MM/DD/YYYY // Important Message Do NOT photocopy the cover sheet containing the barcode. For barcodes to work the sheet with the barcode must be an original not a copy. Use a separate two-page cover sheet for each household. Do NOT use the same two-page cover sheet to send items for more than one household. Always mail or fax verifications to the address or fax on the letter requesting the verifications. If you are not sure where to fax or mail documents contact the MassHealth Customer Service Center at 1-800-841-2900. Fax or Mail Information for Health Connector or MassHealth Type of Document Where to Send New paper applications for subsidized assistance with paying health coverage including Health Connector ConnectorCare plans and those seeking premium tax credits MassHealth or HSN coverage Eligibility verification documents for MassHealth and the Health Connector Subsidized applications and verifications for eligibility should be sent to Health Insurance Processing Center P. O. Box 290794 Charlestown MA 02129 Please allow time for the Health Connector or MassHealth to receive your documents and process them* If your benefits have ended and you need medical services call the MEC at 1-888-665-9993 TTY 1-888-665-9997 for people who are deaf hard of hearing or speech disabled. This facsimile transmittal may contain information that is privileged confidential or exempt from disclosure under applicable law. It is intended for the use of only the individual or department to whom it is addressed* If you are not the recipient or the employee or the agent responsible for the delivery of this transmittal to the intended recipient please notify the sender by telephone at the above number and destroy the attached documents. Anyone other than the intended recipient is hereby notified that any dissemination distribution or copying of this communication is strictly prohibited* HC-CS 02/15 Page 1 of 2 Applicant/Member Information Please print clearly. Use this cover sheet plus the first page containing the barcode when mailing or faxing documents to the Health Connector or MassHealth. Sender Name Soc* Sec* No Phone No Date of birth MassHealth ID No* if applicable Name of Facility if applicable Reference ID No* if applicable Number of pages including both cover sheets applicable law. It is intended for the use of only the individual or department to which it is addressed* If you are not the recipient or the employee or the agent responsible for the delivery of this transmittal to the intended recipient please notify the sender by telephone at the above number and destroy the attached documents.

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