Change of Status Form Spanish Language

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you get coverage through your employer and you need to update your information with us, but you need a form in Spanish, use this one.

Access the form here: Change of status form Spanish language (PDF)

What you’ll need:

  • Your enrollee ID card
  • A printer to print the form
  • An envelope and postage to mail the form, or a fax machine. Each form includes instructions on where to send it.

If you have any questions, please contact us.

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