Transcription of Health Care Programs Application - Green …
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Health Care Programs Application - Green …
Health care Programs Application Applying for these Programs is a multi-step process. Start by filling out this form. First name, middle name, last name & suffix (Jr., Sr., III, etc.) Social Security number Date of birth (mm/dd/yyyy) Phone number where you can be reached ( ) Town where you live Mailing address line 1 Apartment or suite number Mailing address line 2 (If applicable, include an in- care -of person here.) City State ZIP code Green Mountain care is the name of some of our Health care Programs for Vermonters. These Health care Programs are not associated with Vermont Health Connect. We will screen you for the Health care program for which you are eligible. In order to do so, we may ask you for more information. If you are eligible, you may have to pay a premium based on your income.
111. Does anyone have health insurance, including veterans, military or Medicare supplement policies? Include insurance for any child in your home even if they are covered by a parent not in your home.
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