Get Iowacare Online Application Form

The Iowacare Online Application Form is designed to help individuals apply for limited health care services in Iowa. This guide will provide you with step-by-step instructions on accurately filling out the form online to ensure you receive the assistance you need.

Follow the steps to fill out the Iowacare Online Application Form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering your personal information in the 'Tell Us About You' section. Provide your full name, telephone number, street address, mailing address (if different), city, state, and zip code.
3. In the 'People in Your Home' section, list all individuals living in your home, and indicate whether you are applying for each person. For each individual, include their first and last name, sex, relationship to you, birth date, social security number, race (optional), and citizenship status.
4. If applicable, provide information about anyone in your home who is disabled or pregnant, including due dates. Mention if you have any unpaid medical bills and where the services were provided.
5. Complete the 'Income' section by detailing the sources and amounts of income received by each household member. Include information from work, self-employment, unemployment benefits, Social Security, and other sources.
6. Fill out the 'Resources or Assets' section. List any cash or assets, their value, and location. This includes checking accounts, vehicles, insurance, and other financial resources.
7. In the 'Health Insurance' section, answer questions regarding coverage such as Medicare, other health insurance, and employer-offered health plans. If applicable, indicate how many children are covered by the Healthy and Well Kids in Iowa (hawk-i) program.
8. Review the 'Your Signature and Understanding' section. Ensure that you understand the terms, including potential premium payments and cooperation with benefit assignments. Sign and date the form.
9. If someone assisted you in completing the form, their signature and date should also be included in the designated area.
10. Finally, save your changes, and you will have the option to download, print, or share the completed application form.

Complete your Iowacare Online Application Form online today to apply for health care assistance.