Get Application For Health Coverage And Help Paying Costs ... - Nh.gov - Nh

This guide provides a clear and supportive framework for completing the application for health coverage and financial assistance. Follow these steps to ensure that your application is filled out accurately and efficiently to maximize your health coverage options.

Follow the steps to complete your application effectively.

1. Click 'Get Form' button to obtain the form. This will allow you to access the application document that needs to be filled out.
2. Begin by providing personal information about yourself. This includes your full name, home address, phone number, email address, and date of birth. Be sure to answer questions regarding your social security number and citizenship status.
3. Next, provide information about your employment status and income. Fill out details for any jobs you have, including employer names, wages, and the hours you work weekly. If you are not employed or are self-employed, follow the instructions for those sections accordingly.
4. Indicate your current health coverage status. If you have any existing health insurance, please provide the relevant details, including policy numbers and the type of coverage.
5. Read and sign the application. Ensure you understand the declarations regarding the truthfulness of the information provided and your rights concerning health coverage and reporting changes.
6. Mail your completed application to the specified address. Remember to keep a copy for your records.
7. After submission, expect to receive follow-up instructions within 1 to 2 weeks regarding your health coverage eligibility.

Complete your application online today to receive the health coverage you need.