Open Enrollment Appointment 1 Personal Information2 Insurance / Language3 Choose Appointment Date / Time4 Confirm Appointment Name* First Last Mobile Phone Number*Please provide a mobile phone number.Agree to receive SMS Text Messages:* I agree to receive SMS Text Messages I authorize Nevada Medication Assistance Program (NMAP) and Access to Healthcare Network (AHN) to contact me by SMS text message for program related information.EmailBy providing your email address, you will receive email notifications regarding this appointment from Nevada Department of Health and Human Services. Enter Email Confirm Email Date of Birth* MM DD YYYY Insurance / Lanuguage*Choose the type of insurance and language preference.Please Choose Insurance / Language Medicare – English or Spanish Medicaid – English Medicaid – Spanish Employer Sponsored Plan – English Employer Sponsored Plan – Spanish Health Plan of Nevada – English Health Plan of Nevada – Spanish Ambetter – English Ambetter – Spanish Anthem – English Anthem – Spanish No Insurance – English No Insurance – Spanish Other Insurance - English Other Insurance - Spanish Please Choose Language Preference*EnglishSpanishOther Insurance*Please tell us what insurance you have. Enrollment Specialist*Please choose your preferred enrollment specialist.Note: Each specialist has different availability dates / times. If a preferred time / date is not available, try choosing a different specialist.No preference Choose Appointment Date / Time* October 2020 Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 {all_fields}CAPTCHA
