Complete and submit the Health-e-Arizona Plus application for AHCCCS Health Insurance, Nutrition Assistance, and Cash Assistance. Assignment of Benefits.An assignment of benefits form (AOB) creates a legal relationship between the provider and the insurance carrier. You may fill out the application form in private. An assignment agreement is between a supplier of services and a Medicare beneficiary. The option of accepting assignment belongs solely to the supplier. You must be a resident of the state of Arizona and a United States citizen or a non-citizen who meets. Medicaid requirements.