The PHIP benefit is only for people who have MaineCare. Directions for filling out the PHIP application Employer and Insurance Information Form Please fill in all requested information on the form. Be sure you list the amount you pay for your policy and if it is an employer plan how often money is deducted from your paycheck. Send this along with your application. Fill out the W-9 form. We need this information in order to send you checks. Send all of the information in the enclosed self-addressed envelope. If you have questions feel free to contact our office. Sincerely Benefits Administrator 1-800-977-6740 Fax 287-7643 MaineCare Private Health Insurance Premium Benefit What is the MaineCare PHIP Benefit The PHIP Benefit pays private health insurance premiums for MaineCare members who qualify. Department of Health and Human Services MaineCare Services Third Party Liability 11 State House Station Augusta Maine 04333-0011 Toll-Free 1-800-977-6740 Fax 207-287-7643 TTY 711 Private Health ....
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How to fill out the ME PHIP Benefit online
The Maine Private Health Insurance Premium (PHIP) Benefit provides assistance to MaineCare members eligible for private health insurance premium payments. This guide will help you navigate the online process of completing the necessary application form with clear and supportive instructions.
Follow the steps to complete your application effectively.
- Press the ‘Get Form’ button to access the ME PHIP Benefit form and open it in your preferred editing platform.
- Complete the Employer and Insurance Information Form by entering your details, including your employer's name, contact information, and how much is deducted from your paycheck for your policy. Indicate the frequency of deductions and the specifics of your coverage.
- Fill out the W-9 Form with the policyholder's name, address, social security number, signature, and date. This form is requested by the accounting department to process reimbursement.
- Complete the Direct Deposit Form, ensuring the policyholder's bank account number and routing number are accurate. Include a letter from your bank, confirming these details.
- In the MaineCare Participants Form, list each individual's name, their relationship to the policyholder, MaineCare ID number, and birth date. This helps clarify who is covered by the insurance.
- Review all filled sections for accuracy and completeness before saving or submitting the form. Ensure all required documents are included.
- At this stage, you can save your changes, download, print, or share the completed form according to your needs.
Start filling out your ME PHIP Benefit application online today!
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