For more information on the policies and procedures around case association, and when to use this form, please review MNsure's Assister Case Association Policy and Navigator Case Association Form Policy

This form should not be submitted if a navigator has already used another method of associating with the consumer’s application or enrollment.

In order for complete information to be submitted, this form should be completed in one sitting. If you leave and come back, data will not be saved.
The Navigator and member/applicant must fully complete this form and submit it to MNsure.
Navigator Information

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* 1. Navigator Full Name (First Last, e.g. Jane Doe)

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* 2. Navigator Organization

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* 3. Navigator ID # (xxxNAVxxx)

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* 4. Navigator Phone Number (no dashes: format as 9999999999)

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* 5. Navigator Email Address

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