Transcription of Pre-enrollment Qualification Assessment Tool - Health Net
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Pre-enrollment Qualification Assessment Tool - Health Net
Health Net jade (HMO SNP). Pre-enrollment Qualification Assessment Tool Health Net jade is a Medicare Advantage Special Needs Plan (SNP) designed for people with chronic conditions such as diabetes, chronic heart failure and certain cardiovascular disorders. Enrollee information Last name: First name: MI: Medicare ID number (HICN): Date of birth: Phone number: Please complete and submit this form with your enrollment application. If you can answer Yes or Not sure to any of the following questions, you may be eligible to join our chronic care SNP. When this form is completed and submitted along with an enrollment application, you will be enrolled into Health Net jade .
Health Net Jade is a Medicare Advantage Special Needs Plan (SNP) designed for people with chronic conditions such as diabetes, chronic heart failure and certain cardiovascular disorders. Material ID # Y0035 _2014_0047 (H0351, H0562, H6815) CMS Accepted 09022013
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