ApplyAmeriHealth® HMOBasic Eligibility Requirements*
Instructions for mailing your applicationIf you would prefer download an AmeriHealth HMO, Inc. You may request an effective date of the 1st or the 15th of the month. We prefer that you submit your completed application and premium payment at least two weeks before your requested effective date. Your coverage will be effective on the requested date, or no later than the 1st of the month following the month in which a completed application is dated and the premium is received. *Eligibility requirements are determined under the Individual Health Coverage Reform Act of 1992, P.L. 1992, c. 161. |