Forms List
Links to forms used in this course are found below and on pages throughout the course at the time a form is referenced. Although you are not required to print these forms, you will need them available as you take the course. You may choose to gather the forms from your county forms supply, or print them from eDocs using the following links.
DHS-3354 Managed Care Guide to Health Plan Enrollment (PDF).
DHS-3354C Managed Care Pre-Enrollment Questionnaire (PDF).
DHS-3860 Minnesota Health Care Programs Summary of coverage, cost sharing, and limits (PDF).
DHS-4106A Health Plan Enrollment Form (PDF).
DHS-4106C Health Plan Enrollment Form for people 65 or older (PDF).
DHS-4840 Health Plan Choices by County for MSHO (PDF).
DHS-5025 MSC+ Health Plan Choices by County (PDF).
DHS-5218 Health Plan Choices by County for Special Needs BasicCare (PDF).
DHS-5567 Guide to SNBC Enrollment (PDF).
DHS-6451 Special Needs BasicCare (SNBC) Opt-Out Form (PDF).
Page 5
Introduction