Get Covered California Application Form - David Fluker Insurance ...

Filling out the Covered California Application Form is an essential step for individuals and families seeking affordable health insurance options in California. This guide provides clear, step-by-step instructions to help you navigate the form efficiently and confidently.

Follow the steps to complete your online application easily.

1. Press the ‘Get Form’ button to obtain the application form and open it in your browser.
2. Begin by providing your personal information. Fill in your first name, middle name, last name, suffix (if applicable), and your home address. Ensure that you include the correct city, state, ZIP code, and county.
3. Indicate your preferred contact methods. Provide your best phone number and any alternative contact number. Be sure to specify your preferred language for correspondence.
4. If applying for an infant under one year old, indicate if the mother was enrolled in Medi-Cal or the Access for Infants and Mothers (AIM) program at the time of delivery.
5. Next, provide information about your family. Include the details for each family member who will be on the application. This includes spouses, children living with you, and all parents living in the home.
6. For each person listed, fill out their personal information, including their date of birth, gender, relation to you, and whether they are applying for coverage.
7. Complete the income information section by detailing your earnings and employment status. This includes listing any other sources of income as applicable.
8. If necessary, fill in attachment forms, including those related to previous insurance coverage and any required health statuses.
9. Review your application for accuracy and completeness before proceeding to the final step.
10. Finally, sign and date the application. Once complete, you can save the changes, download a copy, print it, or share the completed form as required.

Complete your Covered California Application Form online today for quick and easy access to affordable health insurance options.