Form Fa-001 - Application For Benefits Page 9

ADVERTISEMENT

Do you need help with this application? Visit
or call 1-855-HEA-PLUS (432-7587).
How to choose a health plan
You need to choose a health plan that serves your county.
• All AHCCCS health plans provide the same covered medical services.
• Before choosing a health plan, check with your doctor, pharmacy or hospital to see if they
work with the plan that you want. If you want more information about the doctors, specialists
or hospitals that work with a health plan that serves your county, call the number listed below
for the health plan or visit the plan’s website.
• American Indian members may choose from American Indian Health Program or an AHCCCS
health plan.
• If you do not choose a health plan, one will be assigned to you.
• If you have been enrolled in an AHCCCS health plan within the past 90 days, you may be
enrolled with your previous health plan.
• If you need help selecting a health plan you may:
visit or
o
speak to a Beneficiary Support Specialist by calling (602) 417-7100.
o
Health Plan
Counties Served
• Apache
• La Paz
• Pima
United Health Care Community Plan
• Cochise
• Maricopa
• Santa
Phone Number: 1-800-348-4058
• Coconino
• Mohave
Website:
Cruz
• Yavapai
• Graham
• Navajo
• Yuma
• Greenlee
• Apache
• Gila
• Pima
Health Choice Arizona
• Coconino
• Maricopa
• Pinal
Phone Number: 1-800-322-8670
Website:
Health Net Access
• Maricopa
Phone Number: 888-788-4408
Website:
American Indian Health Program
Phone Numbers:
• All counties except Maricopa County:
All Arizona Counties
1-800-654-8713
• Maricopa County: 602-417-7100
Website:
• Cochise
• Pima
• Yavapai
University Family Care
• Gila
• Pinal
• Yuma
Phone Number: 1-800-582-8686
• Graham
• Santa Cruz
Website:
• Maricopa
• Pima
Care First Arizona
Phone Number:
1-866-560-4042
• Maricopa
• Pima
Mercy Care Plan
Phone Number: 1-800-624-3879
Website:
If the ZIP Code is:
A health plan must be selected from the following county:
85220, 85242, 85342, 85358 or 85390
Maricopa
85292
Gila
85643
Cochise
85645
Santa Cruz
85943
Navajo
86336, 86340 or 86434
Yavapai
86351
Coconino
FA-001 (12-17)
Page
I

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Fa-001 - Application For Benefits - Arizona Department Of Economic Security Form Fa-001 - Application For Benefits - Arizona Department Of Economic Security Legal
Form Fa-1 - Application For Farmland Assessment Form Fa-1 - Application For Farmland Assessment Financial
Form L025.001 - Application For Registration Of Foreign Limited Liability Company - 2010 Form L025.001 - Application For Registration Of Foreign Limited Liability Company - 2010 Legal
Form C002.001 - Application For Reservation - Arizona Corporation Commission 2010 Form C002.001 - Application For Reservation - Arizona Corporation Commission 2010 Legal
Form C025.001 - Application For Withdrawal - 2010 Form C025.001 - Application For Withdrawal - 2010 Legal
Form C017.001 Application For Officer/director/shareholder Change Form 2010 Form C017.001 Application For Officer/director/shareholder Change Form 2010 Legal
Form Dopl 001 - Application For Renewal Form Form Dopl 001 - Application For Renewal Form Legal
Form Cc-001 - Application For Child Care Assistance - Arizona Department Of Economic Security Form Cc-001 - Application For Child Care Assistance - Arizona Department Of Economic Security Legal
Form Cc-001 - Application For Child Care Assistance Form Cc-001 - Application For Child Care Assistance Legal
Va Form 21-0304 - Application For Benefits For Certain Children With Disabilities Born Of Vietnam And Certain Korea Service Veterans Va Form 21-0304 - Application For Benefits For Certain Children With Disabilities Born Of Vietnam And Certain Korea Service Veterans Legal

Related Categories

Parent category: Legal
Download
Go
Page of 31