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APPLICATION INFORMATION

Please tear this page off and keep it for your INFORMATION . APPLICATION INFORMATION CHIP | UPP | MEDICAID | HPE | BYB | Marketplace WHAT AM I APPLYING FOR? Health coverage is important for you and your family to get the medical care you need. When you submit this APPLICATION , you will be considered for all medical programs that are now open for enrollment, including: CHIP (Children s Health Insurance Program)Provides medical and dental insurance for uninsuredchildren in families who qualify based on family size andincome. For more INFORMATION , visit: UPP (Utah s Premium Partnership for Health Insurance)Provides a monthly premium reimbursement when apreviously uninsured individual or family enrolls in theiremployer s health plan or COBRA. For more INFORMATION ,visit: BYB (Baby Your Baby)Provides temporary Medicaid coverage for pregnantwomen who qualify based on preliminary INFORMATION .

If more information is needed to determineyour eligibility for benefits, an eligibility worker from DWS will contact you. If you have not heard from DWS within 10 days, please calltoll-free 1-866-435-7414. We can best determine your eligibility if all questions are answered. However, for HPE and BYB, at a minimum you must fill outthe

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medicaid.utah.gov

Section I General Information Table of Contents ... Section 1 - General information applicable to all providers. It provides general information ... The contents of the Utah Medicaid Provider Manual are updated . Utah Medicaid Provider Manual Section I: General Information

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Disease Overview ... frequently prescribed therapeutic class in the United States, with over 80 million prescriptions dispensed.4. 6 Table 1. Comparison of Benzodiazepine Agents1,2,5,6 Product Route of Administration ... Oral 2.5/5 mg Treatment of irritable bowel syndrome N/A …

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