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Get Hardship Exemption Form
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How to fill out the Hardship Exemption Form online
Navigating the process of applying for a hardship exemption can be daunting, but this guide aims to simplify the steps for you. By following these instructions, you will efficiently complete the Hardship Exemption Form online.
Follow the steps to successfully complete your application.
- Click the ‘Get Form’ button to obtain the Hardship Exemption Form and access it in the online editor.
- Begin filling out the form by providing your personal information, including your first name, middle name, last name, suffix, home address, city, state, ZIP code, and a valid phone number. If applicable, include an email address for updates regarding your application.
- In this step, provide details about your tax household. List out the individuals seeking the exemption, including yourself. For each person, include their first name, last name, relationship, date of birth, and social security number, if available.
- Specify the hardship you experienced by referring to the hardship categories. Identify the number corresponding to the hardship that affected you, and describe how this hardship prevented you from obtaining health coverage.
- Document the beginning and end dates of the hardship. If you are still experiencing the hardship, ensure to indicate this on the form.
- Review all the information provided and sign the application. A signature is required to verify that the information is accurate and that you understand the implications of providing false information.
- Finally, submit your completed application either by mailing it to the Health Insurance Marketplace or providing it to the health plan if seeking catastrophic coverage. Be sure to keep a copy for your records.
Complete your application for the hardship exemption online today.
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Unlawful Resident Individuals who are not lawfully present in the United States are exempt. Coverage Gap No penalty will be imposed on those without coverage for less than three months, but this exemption applies only to the first short coverage gap in a calendar year.
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