Dhs 6696-2026

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The document DHS-6696-ENG 11-21 is an application form for health coverage and financial assistance in Minnesota. It provides information on how to apply for health insurance, eligibility criteria, required documentation, and the types of coverage available, including Medical Assistance and MinnesotaCare. The application can be completed online for faster processing, and it includes sections for family members, income details, and consent for sharing medical information. Additionally, it outlines privacy practices and rights related to health coverage.

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Click ‘Get Form’ to open the DHS 6696 application in our platform.
Begin by filling out the 'People to include on this application' section. List all family members living with you, including yourself, spouse, and children under 19.
Proceed to Step 2 for each person listed. Enter their first name, last name, date of birth, and sex. Ensure to provide a Social Security number if available.
Complete the income information for each family member. This includes employer details and expected wages. Use our editor's features to easily input and adjust figures.
Review your entries for accuracy before submitting. Utilize the 'Preview' feature in our platform to ensure all information is correct.
Once completed, follow the instructions in Step 8 to submit your application via fax, mail, or in person.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (110 Votes)
2016	4.4 Satisfied (34 Votes)

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Can you apply for medical any time of the year?

You can apply for Medi-Cal at any time of the year by mail, phone, fax, or email. You can also apply online or in person. You can only apply for Covered California coverage on certain dates. To learn when you can apply, go to .coveredca.comor call1-800-300-1506 (TTY 1-888-889-4500).

Who is eligible for MNsure coverage?

To be eligible to enroll in coverage through MNsure you must: Be a resident of Minnesota. Be a U.S. citizen or national, or be lawfully present. Not be incarcerated.

What is the difference between MinnesotaCare and MNsure?

Coverage Options through MNsure Medical Assistance: Covers low-income Minnesotans, including children and pregnant women, as well as people with disabilities. There is no monthly premium. Enrollment is available year-round. MinnesotaCare: Covers lower-income Minnesotans who arent eligible for Medical Assistance.

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Can I enroll in MNsure anytime?

You can enroll any time of year if you qualify for Medical Assistance or MinnesotaCare, or are a member of a federally recognized American Indian tribe.

Can you enroll in MNsure anytime?

Year-round enrollment: If you qualify for Medical Assistance or MinnesotaCare, or are a member of a federally recognized American Indian tribe, you can enroll any time of year.

Is Minnesota open enrollment?

Minnesota has an open-enrollment policy. That means a child can be enrolled in a school inside or outside of the school district in which the family lives.

Dhs 6696-2026

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