Follow the steps to fill out the NE CSI CSAPP2010MI form online.

1. Press the ‘Get Form’ button to access the form and open it in the editing interface.
2. In Section A, enter the proposed insured information. Fill in your name as it appears on your Medicare card, along with your resident address, phone number, city, state, zip code, date of birth, current age, gender, social security number, Medicare card number, email address, height, and weight.
3. Move to Section B, where you will specify your plan and premium information. Select the requested policy effective date, and specify the premium amount and policy fee. Decide on your initial bank draft details, including the issue date and amount, and choose your payment mode and method.
4. In Section C, answer all eligibility questions regarding your coverage status under Medicare Part A and B, and whether you are applying during a guaranteed issue period.
5. Proceed to Section D, which asks health-related questions. If applicable, indicate your tobacco usage and provide answers to questions about your current health status and medical history.
6. In Section E, provide your medication history if you have taken any prescription or over-the-counter medications in the last 12 months. List the medications along with the prescribed dates, dosage, frequency, and the conditions they are for.
7. Answer the questions in Section F regarding any existing health insurance coverage you may have, follow the prompts, and provide the necessary details.
8. Finally, complete the authorization and certification section by signing and dating the application. Review the important statements before signing to ensure you understand the commitments and conditions.
9. Once all sections are completed, you can save your changes, download, print, or share the form as needed.

Begin your application for Medicare supplement coverage by filling out the NE CSI CSAPP2010MI form today.