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Health Benefits for Workers with Disabilities Mail-In Application Voter's

Health Benefits for Workers with Disabilities Mail-In Application Voter's 2025

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The document is a mail-in application for the Health Benefits for Workers with Disabilities program in Illinois. It outlines eligibility criteria, covered medical services, and instructions for completing the application. The document emphasizes that it is not an application for cash assistance or food stamps and provides contact information for additional resources. It includes sections to gather personal information about the applicant, their health insurance status, household members, assets, employment details, and disability information. The application process requires proof of identity and income, and applicants are advised to keep a copy of their submission.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the applicant's information, including name, birth date, and Social Security Number. Ensure all fields are completed accurately.
Provide details about your health insurance and any unpaid medical bills. Indicate whether you have health insurance and attach a copy of your insurance card if applicable.
List all individuals living with you, including their names and relationships. This section is crucial for determining eligibility for benefits.
Detail your assets and employment status. Include information about vehicles, property, and any income sources outside of employment.
Complete the disability section by checking the boxes that best describe your condition. This helps in assessing your eligibility for specific benefits.
Review all entries for accuracy before signing the application. Make sure to attach any required documentation as specified in the instructions.

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