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Form F-10111 Good Faith Medicaid / Badgercare Plus Certification - Wisconsin
What Is Form F-10111?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-10111?
A: Form F-10111 is the Good Faith Medicaid/Badgercare Plus Certification for Wisconsin.
Q: What is Medicaid/Badgercare Plus?
A: Medicaid/Badgercare Plus is a public healthinsurance program in Wisconsin that provides coverage for eligible low-income individuals and families.
Q: What is the purpose of Form F-10111?
A: The purpose of Form F-10111 is to certify that an individual has made a good faith effort to apply for and obtain other health insurance coverage.
Q: Who needs to complete Form F-10111?
A: Form F-10111 needs to be completed by applicants for Medicaid/Badgercare Plus who are not already enrolled in or eligible for other health insurance coverage.
Q: What information is required on Form F-10111?
A: Form F-10111 requires personal information, such as name, address, and social security number, as well as information about other health insurance programs the applicant is enrolled in or eligible for.
Q: When should Form F-10111 be submitted?
A: Form F-10111 should be submitted at the time of application for Medicaid/Badgercare Plus or when there is a change in the applicant's circumstances with regard to other health insurance coverage.
Q: What happens if Form F-10111 is not submitted?
A: Failure to submit Form F-10111 may result in a delay or denial of Medicaid/Badgercare Plus eligibility.
Q: Are there any fees associated with Form F-10111?
A: No, there are no fees associated with completing and submitting Form F-10111.
Form Details:
- Released on September 1, 2013;
- The latest edition provided by the Wisconsin Department of Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form F-10111 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
