Get Application For Health Coverage & Help Paying Costs - Texas Health ...

Filling out the application for health coverage in Texas can be a straightforward process when you understand each section and its requirements. This guide aims to provide you with clear, step-by-step instructions to successfully complete the application online.

Follow the steps to complete your application efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your personal details as the primary contact. This includes your first name, middle name, last name, home address, city, state, ZIP code, county, and contact number. Indicate if you live and plan to stay in Texas, and provide an email address if preferred for communication about your application.
3. Under the family section, list everyone who needs to be included in the application. This includes yourself, your spouse, and any children under 21 living with you, as well as anyone on your tax return. If you live in Texas, you don’t have to provide Social Security numbers for family members not applying for coverage.
4. Provide information for each family member included in the application. This step includes answering specific questions about their relationship to you, their date of birth, sex, and Social Security number, if applicable. Include details about their health coverage status and any relevant questions regarding ongoing coverage.
5. Report income details for all included family members. For individuals who are currently employed, fill out the job and income sections accurately. Specify wages, hours worked, and any other forms of income. Include any deductions that could apply.
6. Review your family's current and past health coverage ensuring all necessary information is provided. Indicate if anyone is receiving coverage from Medicaid, employer insurance, or any other programs.
7. Read through and sign the application. Ensure you understand the declaration regarding penalties for providing false information. If using an authorized representative, include their details in Appendix C and sign where necessary.
8. Submit your completed application by faxing or mailing it to the designated address. Make sure to keep a copy for your records and confirm submission to ensure smooth processing.

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