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mySoonerCare – Member Enrollment

Today is April 24, 2014
  • STEP 2
  • STEP 3
  • STEP 4
  • STEP 5
  • STEP 6
  • STEP 8

Step 1 - People & Contacts

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The first step in the application process is to tell us about all of the people living in the household.
Start with an adult, if there is one living in the house. He or she will be the contact person for the case. The contact person must be at least 15 years old. When you have finished, select "Next" to continue.
Required fields are marked with an asterisk (*).
Personal Information
(Full legal name as appears on Social Security card, not a nickname; example: Joseph, not Joe; Susan, not Sue)
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Type your first name, middle name and last name in the boxes. Please be sure to use your full, legal name. Don't use nicknames on this application. If you have two last names, type them both into the last name box. If your name doesn't fit in the boxes, just type as much as you can.
SSN: *
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All household members are considered for benefits and must enter their SSN.
If you are not a citizen or resident alien, then you would not have an SSN to list here.
Everyone who is a citizen or resident alien is required to have an SSN and must supply it on the application.
• Since a child under the age of 1 might not have received his SSN yet from the Social Security Office, he is allowed to list all zeros for his SSN until he receives it or until he turns 1.
• If you do not know your SSN, contact the Social Security Office for assistance in getting a replacement card and documentation of your number.
• If you are not a citizen or resident alien, then you would not have an SSN to list here. You may enter all zeros.
• If you are a Refugee and do not have a Social Security Number (SSN) yet because you just arrived in America, you should list all zeros for your SSN and then contact the Social Security Administration for assistance in applying for your number. You will have to provide proof that you applied for your SSN within 10 days.
Re-enter SSN: *
Date of Birth: *

Gender: *
Race & Ethnicity
(check all that apply)

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SoonerCare cannot discriminate for reason of race or ethnic background, religion, gender, sexual orientation or political affiliation. Race is used for statistical purposes only.
Is this person of Hispanic or Latino origin (or descent)?
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A person of Cuban, Mexican, Puerto Rican, South American, Central American, or other Spanish culture of origin regardless of race. A person may have Hispanic background in combination with any race.
Residency & Citizenship
Does this person live in Oklahoma? *
If you have to verify the citizenship or alien status for this person we may need additional documentation. Can you provide a document or have you ever had a document that shows this person

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Persons born in the U.S. or to U.S. citizens in foreign countries are citizens of the United States.
Persons born in other countries who want to become citizens must apply for and pass a citizenship test. Those who become citizens in this manner are naturalized citizens.
Requested Benefits
Please select each benefit this person would like to apply for:
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This application will submit your information for an eligibility determination for SoonerCare (Oklahoma Medicaid). If found ineligible for SoonerCare your information with be forwarded to the Federally Facilitated Marketplace for a determination for Insurance Affordability Programs (IAP) and Advanced Premium Tax Credits (APTC).
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Sooner Plan
SoonerPlan offers family planning services such as birth control information and supplies; laboratory tests related to family planning services; office visits and physical exams related to family planning; pregnancy tests for women; and vasectomies for men age 21 and over.
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