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.



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