Get Tufts Health Plan -- Application Form - Tufts Health Freedom Plan

This guide provides a step-by-step approach to completing the Tufts Health Plan application form for the Health Freedom Plan. It is designed to assist users in filling out the form accurately and efficiently to ensure smooth enrollment.

Follow the steps to complete your application form successfully.

1. Press the 'Get Form' button to access the application form and open it in your document editor.
2. Begin by completing the employer section, ensuring all fields are filled out clearly. This includes the group/company name, group number, office location, date of hire, and effective date of coverage.
3. Select the type of enrollment by checking the appropriate box, such as 'New Hire', 'Open Enrollment', or 'COBRA', and specify any qualifying event and its date if applicable.
4. In the member section, enter your product code by selecting the corresponding letter from the provided list, along with your personal information, such as your last name, first name, middle initial, primary language, Social Security number, date of birth, and gender.
5. Provide your mailing address, home telephone number, marital status, and type of coverage requested, making sure to fill in all required fields.
6. List all members enrolling, including their names, sex, date of birth, and primary care provider ID if applicable. Mark whether each member is currently using the listed primary care provider.
7. Indicate if there are additional membership applications for dependent children and specify any other health insurance coverage that applies, filling in all required information.
8. Sign and date the form, confirming the information provided is accurate. Share the completed application with your employer for further processing.
9. Keep the yellow copy as your temporary ID, give the pink copy to your employer, and ensure the original white copy is mailed to Tufts Health Plan.
10. Once the application is complete, you can save your changes, download, print, or share the filled document as needed.

Complete your Tufts Health Plan application form online today to ensure prompt enrollment.