INFORMATION ABOUT OPEN ENROLLMENT:
v Our next Open Enrollment is: June 11, 2013
v Phones open at 8:30 a.m. We will not take anyone at the front door.
v The phone number is: (313) 692-8429. We only take one person per call.
v If you get a busy signal, please continue to call back again.
v Our open slots are typically filled within 20 minutes.
v During registration, we will take your name, birth date and phone number. We will then call you back within a week or two to set up your first appointment.
v You must be a City of Detroit resident between the ages of 18 and 64, have no health insurance and are not assigned a medical home under VODI (Voices of Detroit).
PATIENT INFORMATION: Once you become a patient at MPCC, please bring the following information with you at your first visit and every six months thereafter:
v A valid picture ID: State of Michigan ID OR Michigan Driver's License OR Passport.
v Employer Letter: If you are working, a letter from your employer on their letterhead stating that you are an employee and not receiving health insurance through your workplace.
v Proof of household income: A current year 1040 Federal Income Tax Form (only needs to be shown once a year).
v If you DO NOT have a current 1040, you will need to sign an IRS 4506-T form, a document that lets us confirm with the IRS that you did NOT file.
v One of the following documents listed below will be required when signing a 4506-T Form and should be brought in annually when you are due to renew your paperwork:
o A current year W-2 Form, for all wage earners in the household. If you do not have one, then:
o A current year Social Security/Disability Statement, for anyone in the household who has one. If you do not have this, then:
o A current year pension (Retirement Income Statement), for anyone in the household who has one. If you do not have this, then:
o Two current unemployment income receipts (if you are currently receiving unemployment benefits). If you do not have this, then:
o A current year FIA letter (Family Independence Agency) showing $0.00 income or Food Stamp award letter (both of these are a six-month update requirement):
§ If your FIA letter shows any amount in the income portion, you must bring in proof of that income.
§ If your FIA letter shows $0 in the income portion, you will need a letter from the person who is supporting you financially stating the average dollar amount they contribute for your support. It will need to include the date, their relationship to you, their phone number and signature.
v If you currently have no income ($0.00), we will need a letter from the person who is supporting you financially stating the average dollar amount they contribute for your support. It will need to include the date, their relationship to you, their phone number and signature. This will need to be updated every six months.
v Failure to bring all of the above items or sign needed forms at the next office visit will result in having to reschedule the appointment. You will also be required to update the patient demographic sheet when needed.