Get Health Insurance Risk Sharing Plan Application For Reduced Premium 2012 Form

Filling out the Health Insurance Risk Sharing Plan Application for Reduced Premium 2012 Form is a crucial step for individuals seeking financial relief through reduced premiums, deductibles, and out-of-pocket maximums for health insurance. This guide provides clear, step-by-step instructions to ensure that you complete the application accurately and efficiently online.

Follow the steps to successfully complete your application

1. Click the ‘Get Form’ button to access the Health Insurance Risk Sharing Plan Application For Reduced Premium 2012 Form and open it in your browser.
2. Begin by filling out the Member/Applicant Information section, which requires your last name, first name, middle name, street address, date of birth, city, telephone number, state, ZIP code, HIRSP identification number, and optional Social Security number.
3. Indicate your marital status by selecting ‘Yes’ or ‘No’ for being married, divorced, or separated in the previous year, and specify if you are under 18.
4. In the Household Income section, report your income from your 2011 Wisconsin income tax return on line 4. If you did not file a tax return, provide taxable income amounts on lines 5a and 5b as applicable.
5. Complete line 6 by disclosing all nontaxable household income received in 2011, including types listed in the form, ensuring not to duplicate amounts reported previously.
6. Calculate your total household income by adding the amounts filled in from lines 4 to 6r, then apply the dependent deduction on line 7b if applicable, and calculate household income on line 7c.
7. Review your application for completeness and accuracy, ensuring that you have attached the required copies of both your 2011 Federal and Wisconsin income tax returns.
8. Sign and date the application, noting any additional signatures required if the member or applicant is under age 18.
9. Submit your completed application along with all necessary documentation to the specified address or via fax as indicated in the instructions.

Begin filling out your application online today to take advantage of potential premium reductions!