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Form ODM06614 Health Insurance Fact Request - Ohio
What Is Form ODM06614?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form ODM06614?A: Form ODM06614 is a Health Insurance Fact Request specific to the state of Ohio.
Q: What is the purpose of Form ODM06614?A: The purpose of Form ODM06614 is to request health insurance information in order to determine eligibility for certain programs or services.
Q: Who uses Form ODM06614?A: Form ODM06614 is used by individuals in Ohio who are seeking health insurance or applying for health-related assistance.
Q: Is Form ODM06614 specific to Ohio only?A: Yes, Form ODM06614 is specific to the state of Ohio and is not used in other states.
Q: What information is required on Form ODM06614?A: Form ODM06614 requires basic personal information such as name, address, and Social Security number, as well as details about current health insurance coverage.
Q: What happens after I submit Form ODM06614?A: After submitting Form ODM06614, the information provided will be reviewed to determine eligibility for health insurance programs or services in Ohio.
Q: Are there any fees associated with submitting Form ODM06614?A: No, there are no fees associated with submitting Form ODM06614. It is a free application form.
Form Details:
- Released on November 1, 2020;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ODM06614 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
