MN SF3337

Applicants using combined applications through the MNsure portal must indicate which coverage options they are applying for: medical assistance, MinnesotaCare, qualified health plans, or any combination thereof.

Applicants are not required to apply for all coverage options listed on the application form.

Combined applications must include a separate, boldface notice in at least 14-point font informing applicants that the state may claim repayment for medical care costs or premiums from the estate of any person enrolled in medical assistance.

Applicants must separately acknowledge receipt of the estate claims notice with a signature within the designated text box containing the notice.

Requirements apply to both paper and electronic applications for medical assistance, MinnesotaCare, and qualified health plans.