Get Me Phip Benefit 2020-2025

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.

1. Press the ‘Get Form’ button to access the ME PHIP Benefit form and open it in your preferred editing platform.
2. 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.
3. 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.
4. 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.
5. 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.
6. Review all filled sections for accuracy and completeness before saving or submitting the form. Ensure all required documents are included.
7. 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!