Get Wisconsin Express Enrollment 2014 Form 2014

The Wisconsin Express Enrollment 2014 Form is designed specifically for pregnant women seeking immediate access to pregnancy-related outpatient services under BadgerCare Plus. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the Wisconsin Express Enrollment 2014 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. In Section I, provide the applicant's information. Start by confirming that the applicant is a resident of Wisconsin. If yes, proceed to enter their full name, birth date, and contact number.
3. Next, enter the applicant's address and county of residence for correspondence purposes. Ensure that the provided address allows for timely receipt of notices regarding enrollment and benefits.
4. Proceed to ask if the applicant is currently receiving Wisconsin Medicaid or BadgerCare Plus. If they are not, continue to the next line.
5. Confirm whether this is the applicant's first Express Enrollment for their current pregnancy. If they have previously received benefits, they are not eligible for new enrollment.
6. Determine if the applicant is a U.S. citizen or lawfully present. If they are not, they will need to be informed of their ineligibility.
7. In Section II, provide pregnancy information, including the expected delivery date and the number of babies anticipated.
8. Move to Section III to fill out income information. Gather financial details including total household size and monthly earned and unearned income for the household.
9. Calculate the total monthly income by adding earned income and unearned income, and ensure this falls within the federal poverty level income guidelines.
10. In Section IV, determine eligibility based on the information provided. If eligible, complete the necessary provider details, ensuring to communicate the duration of temporary coverage.
11. Lastly, complete Section V by filling out the temporary identification card with effective dates and member information. Inform the applicant about receiving a permanent ForwardHealth ID card.
12. Once everything is filled out, save changes, download the form, print it for your records, or share it as necessary.

Complete the Wisconsin Express Enrollment 2014 Form online today to ensure you receive the benefits you need.