Get Ma Ard 2021-2025

Filling out the Massachusetts Authorized Representative Designation Form (MA ARD) online can streamline your application for health care coverage through MassHealth and the Health Connector. This guide will provide you with clear, step-by-step instructions to ensure you complete the form accurately.

Follow the steps to fill out the MA ARD confidently

1. Click 'Get Form' button to obtain the form and open it in your online editor.
2. Complete Section I by providing your name, date of birth, MassHealth ID number, or last four digits of your Social Security number, and your email address. Certify the person or organization you have chosen as your authorized representative by signing and dating the section.
3. If your authorized representative is a person, they need to complete Part B by providing their name, phone number, address, and signature, along with the date. If they are an organization, they must fill out the organization’s name and have a representative sign on its behalf.
4. If you cannot provide a written designation, fill out Section II by providing the applicant's/member’s name, date of birth, MassHealth ID number, and authorized representative’s signature and contact information. This section must be completed by an individual who can act on your behalf.
5. In Section III, if you are legally appointed to act on behalf of an applicant or member, complete the necessary fields, ensuring to submit a copy of the relevant legal document with the form.
6. Review all sections for completeness and accuracy. This ensures your form is processed quickly without delays.
7. Submit your completed form along with your application by mail or fax. If you are already receiving benefits and wish to designate or change an authorized representative, ensure you submit the form as described in the instructions.
8. Finally, save any changes made, and consider downloading or printing the completed form for your records.

Complete your MA ARD online today to designate your authorized representative efficiently.