Coverage to Care Follow Up

I would like for ACCESS to follow up with me regarding my selection in Health Insurance through the Health Insurance Marketplace and/or Healthy Michigan Plan (expanded Medicaid). ACCESS may call me to assist me with any follow up questions regarding my selected plan, such as doctor choice, doctor availability and preventative services. ACCESS may also call me to ensure I am receiving the most benefit out of my selected health care policy. I authorize ACCESS to call me with reminders regarding the open enrollment period in 2021 – to update my policy or change my policy.

Name*

First Last

Applicant Email

Date*

Phone*

Location*

Navigator Email*

Navigator Name*

Notes

Navigator Follow Up Coverage To Care