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My date of birth is 3. a* b. I am attending school name of school and grade I am not attending school* The highest year of education I have completed is 4. My occupation is 5. a* 6. a* c* d. I am employed* My place of employment is name and address I started work there on date I am not employed at the present time. I last worked from starting month and year to ending month end year My gross monthly earnings were I am not receiving welfare or AFDC and I do not intend to apply for welfare or AFDC ...

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Why do I need an authorized representative?

An authorized representative is not always needed but it should be highly considered if the individual is mentally impaired or disabled, or if there are any incompetency in language. In these cases, it is highly advised to appoint an authorized representative.

Where do I send my MC 382 form?

Mail the form to address Access, PO Box 85027, San Diego, CA 92186. Please include the case number on the form when doing so. The form will be scanned into the system and a representative will contact you.

What qualifies as an authorized representative?

A. An authorized representative is an individual authorized under State or other applicable law to act on behalf of a beneficiary or other party involved in the appeal. Authorized representatives have all of the rights and responsibilities of a beneficiary or party, as applicable, throughout the appeals process.

How do I transfer my Medi-Cal to a different county?

You may apply for Medicaid in the state you move to. If you are moving to a new county in California, you also need to tell the county you live in or the county you are moving to. This is to make sure you keep getting Medi-Cal benefits. You should tell your local county office within 10 days of moving to a new county.

What is an authorized representative?

Someone who you choose to act on your behalf with the Marketplace, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf.

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Does LA Care work in other counties?

As a member of L.A. Care Covered, your service area is Los Angeles County (excluding Catalina Island). Routine care is not covered out of service area, but emergency and urgent care services are covered outside of Los Angeles County.

Can you be your own authorized representative?

The answer is anybody. An organization may designate literally anyone to act as their authorized representative for the purpose of filling out Section 2. You are not required to have any formal contract or agreement with this individual either.

Who is the authorized representative?

An authorized representative is an individual authorized under State or other applicable law to act on behalf of a beneficiary or other party involved in the appeal. Authorized representatives have all of the rights and responsibilities of a beneficiary or party, as applicable, throughout the appeals process.

Where do I send my MC 382 form?

How do I add an authorized representative to healthcare gov?

How to appoint a representative Download and fill out a form. Call the Marketplace appeals Center at 1-855-231-1751 to ask us to mail you the form. Write a letter. It must include: Your name, address, and phone number. Your appeal number (if you have one) A statement appointing someone as your representative.

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Why do I need an authorized representative?

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What is an authorized representative?

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Does LA Care work in other counties?

Can you be your own authorized representative?

Who is the authorized representative?

Where do I send my MC 382 form?

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