Appendix K fi AH3-R Renewal Form - 2014-07-14.pdf-2025

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The document is a renewal form for HUSKY Health, which includes Medicaid and CHIP coverage. It provides instructions on how to renew coverage online, by phone, by mail, or in person. The form requires detailed information about household members, income, tax filing status, and any changes in circumstances. It emphasizes the importance of returning the form by a specified deadline to avoid losing coverage and outlines the process for those who may not qualify for HUSKY Health.

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