Get Kaiser Permanente Mfap 2015

This guide provides a clear and concise walkthrough for filling out the Kaiser Permanente Medical Financial Assistance Program (MFAP) application. Follow these steps to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the application effectively.

1. Press the ‘Get Form’ button to acquire the MFAP document and open it for editing.
2. Begin by ensuring you meet the qualification requirements. You must have a gross household income at or below 350% of the Federal Poverty Guidelines, or your out-of-pocket medical expenses must exceed 10% of your annual income. Refer to the relevant guidelines based on your state.
3. Once eligibility is confirmed, complete the patient and household information section. This includes entering full names, birth dates, addresses, and contact information for the applicant and any dependents.
4. Next, provide details about your employment status and any existing medical insurance. Be sure to indicate if you are employed, have other insurance, or are enrolled in Medicare.
5. List your household's gross monthly income accurately. Include income sources such as salary, alimony, self-employment, and benefits, ensuring to report all family members' income.
6. Gather and include proof of income documentation. You must submit your most recent tax return, pay stubs, or other income statements. Only copies of documents are necessary.
7. If applicable, complete the section that details your medical expenses over the past 12 months, providing receipts or invoices for expenses incurred outside of Kaiser Permanente.
8. Review the financial agreement and credit report authorization section, confirming the accuracy of the provided information. Sign and date the application.
9. After completing the form, save your changes, and consider downloading, printing, or sharing it as needed to submit your application.

Start completing your Kaiser Permanente MFAP online today to secure the assistance you may need.