Get Husky A Application Form

This guide provides comprehensive, step-by-step instructions for filling out the Husky A Application Form online. Whether you are new to this process or need assistance, we aim to make it clear and accessible.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section A, check the box or boxes that match your situation to indicate who you want health coverage for. This section helps streamline the processing of your application.
3. Move to Section B and provide your personal details. This includes your first name, last name, date of birth, gender, social security number (if applicable), and contact information. Make sure to include any client ID if you have received benefits previously.
4. In Section C, list all individuals in your household who require health coverage. Include their relationship to you and any required details, such as social security numbers or other relevant information.
5. Section D is for information about other household members who do not wish to apply for health coverage. You may list their relationship with the primary applicant.
6. Complete Section E if you have a child or dependent requiring coverage and provide necessary child support information if applicable. You may opt for an exemption if you have safety concerns.
7. In Section F, document all employment income for individuals in your household who are applying. Ensure to specify gross amounts and include all jobs or self-employment income.
8. Section G requires details on any other income received by household members. Include sources such as child support or Social Security.
9. For Section H, report any day care expenses incurred. This information may help reduce the income calculations that affect your health coverage needs.
10. In Section I, provide health insurance information regarding current or recently terminated coverage. List any medical bills if applicable.
11. If applicable, complete Section J with immigration information for household members who are not U.S. citizens.
12. In Section K, indicate tribal membership if applicable to enable access to subsidized coverage.
13. Finally, carefully read Section L before signing. Ensure all information is accurate, then submit your application either online or by mailing it to the appropriate office.
14. Once all sections are filled out, you can save your changes, download, print, or share the completed application as needed.

Complete your application for health coverage online today for a smoother process.