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....
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How to fill out the MA HC-CS online
Filling out the MA HC-CS online is an essential step for individuals seeking health coverage in Massachusetts. This guide provides clear instructions to navigate the form effectively and ensure that all necessary information is submitted accurately.
Follow the steps to complete the MA HC-CS form online.
- Press the ‘Get Form’ button to access the MA HC-CS form and open it in your online editor.
- Begin by entering the last four digits of the head of household’s Social Security number in the designated field. Alternatively, you can use the head of household initials and their date of birth (MM/DD/YYYY) if you do not wish to provide the Social Security number.
- Carefully complete the applicant/member information section. Ensure you print clearly and accurately fill in the full name of the head of household, their Social Security number (if applicable), phone number, and date of birth.
- If applicable, include the name of the facility and the MassHealth ID number. Also, indicate the reference ID number if you have one.
- Count the number of pages being submitted, including the cover sheet and the first page containing the barcode. Fill in this number in the appropriate field.
- After filling out the form, review all entries for accuracy. Make sure to save the changes in your online editor.
- Finally, you can download, print, or share the completed form as required and ensure it is sent to the correct address provided for the relevant health coverage program.
Complete your MA HC-CS form online today for efficient processing of your health coverage.
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