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Home > > Health Care PlansHow to Submit Your Member Qualification Form

How to Submit Your Member Qualification Form

Have your Personal Care Physician complete your form and submit it to HAP in one of the following ways:

  1. Online by logging into and selecting the Health Engagement application.
  2. Email the form to
    Email Security Notice: Please be aware that HAP cannot guarantee the confidentiality or security of any information you send to us over the Internet when using email.
  3. Fax the form to (248) 552-9416.
  4. Mail the form to HAP 26877 Northwestern Hwy., Ste. 420, Southfield, MI 48033-9903.

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