Get Ipxp Eligibility Form 2015-2025

The IPXP eligibility form is an essential document for individuals seeking coverage under the Illinois Preexisting Condition Insurance Plan. This guide provides step-by-step instructions for filling out the form online, ensuring a smooth application process for all users.

Follow the steps to complete the IPXP eligibility form online.

1. Press the ‘Get Form’ button to access the eligibility form and open it in your preferred online editor.
2. Begin by filling out your applicant information in Section 1. Include your first name, middle name, last name, residential address (no P.O. Box or business address), maiden name (if applicable), city, state, zip code, social security number, birth date, age, and contact numbers (home, work, and cell). Answer the tobacco use question as well as your gender and marital status.
3. In Section 2, provide your eligibility qualifications by answering questions about your health coverage history over the last 24 months. Additionally, identify your primary health condition that restricts you from acquiring standard insurance coverage.
4. Next, proceed to Section 3 to select your coverage options. You will automatically be enrolled in the Standard Plan unless you choose the Extended Plan. Specify how you want to pay your monthly premium and identify who will be responsible for the payment.
5. Section 4 requires information about your most recent health insurance. Indicate when your last coverage was, detail the type of coverage, and explain why it ended. Provide necessary information if you are enrolled in Medicare or receiving medical assistance.
6. In Section 5, include any information related to the insurance producer who assisted you with the application, if applicable. Authorize IPXP to discuss your application with this producer if you wish.
7. Section 6 outlines required documentation. Ensure to attach copies of valid documents proving residency, lawful presence in the U.S., and any health insurance coverage documentation as specified.
8. Review and sign Section 7 to confirm the accuracy of your application. Make sure to answer the final checklist questions.
9. Finally, forward your completed application and all accompanying documentation to the specified address for processing.

To complete your application, fill out and submit the IPXP eligibility form online today.