Get Kaiser Permanente Mfap 2022-2025

The Kaiser Permanente Medical Financial Assistance Program (MFAP) provides vital support for people who need help covering medical expenses. This guide will walk you through the process of filling out the MFAP application online, ensuring you have all the information you need to complete it accurately.

Follow the steps to complete your MFAP application online.

1. Press the ‘Get Form’ button to access the application and open it in your preferred editor.
2. Begin by entering your personal details, which includes your name, date of birth, contact number, and address. Make sure all information is accurate.
3. Provide your medical record number, if applicable, and your Social Security number to assist in the application process.
4. Indicate your household size by noting the number of family members living in your home, including partners and children.
5. Enter your total gross household income on a monthly basis. Be sure to check all applicable income types, such as employment wages, business income, or social security, to ensure full reporting.
6. List your out-of-pocket healthcare costs for emergency or medically necessary services over the past 12 months for both Kaiser Permanente and other healthcare providers.
7. If applicable, provide details of all household members applying for assistance by listing their names, dates of birth, relationships, and medical record numbers.
8. If you do not currently have health coverage, check the box to allow Kaiser Permanente to contact you regarding your options.
9. Finally, read the declaration statement carefully, sign, and date the application to confirm that all information is true and complete.
10. Once the application is fully completed, save your changes, then download, print, or share the form as needed.

Take action today and complete your Kaiser Permanente MFAP application online for financial support.