MNsure Navigator Case Association Form- Updated October 2022

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.

Navigator Information

Question Title

* 1. Navigator ID # (xxxNAVxxx)

Question Title

* 2. Navigator Organization

Question Title

* 3. Are you submitting this form because you assisted an inmate with completing a Minnesota Health Care Programs Application

Yes--I was assisting an inmate.