Electronic Signature

The Electronic Signature screen contains the terms, conditions and policies that you must agree to before the application for health benefits can be finalized.

 

If a Community Partner/Assister is completing an application on your behalf, an additional permission statement regarding your phone consent displays. The Community Partner/Assister must check this statement to continue with the enrollment process.

 

After you have provided your signature and checked the appropriate permission statements, select Next to continue.

 

NOTE:The First Name, M.I., Last Name and Suffix details entered on the Electronic Signature screen should match with those entered in at the Applicant Information screen.

 

 

Click here to return to the main menu.