Follow the steps to complete your application smoothly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide information about all family members living with you. Include your spouse, children under 19, and anyone else you claim on your tax return. Don't include dependent children who are 19 or older. This step ensures we assess health coverage options based on your family's needs.
3. Complete the required fields for each person included in your application. Start with your details as Person 1, including your name, date of birth, sex, marital status, and whether you have a Social Security number.
4. Continue filling in the necessary information regarding residence, preferred languages, and contact methods. Ensure all details are accurate as they are essential for processing your application.
5. For each family member, respond to specific questions regarding health coverage status, immigration status, and pregnancy, ensuring clarity on who is applying for coverage.
6. Enter income information for all members applying. This may include employer details, any unemployment benefits, and other sources of income to help us determine the most suitable coverage options.
7. If applicable, complete any appendices if someone is helping you fill out the form or if any members of your family are American Indian or Alaska Native.
8. After entering all required information and confirming its accuracy, review the entire application. Make any necessary edits, then save your changes.
9. Once satisfied, you can download, print, or share the completed form as necessary. Be sure to submit your completed application following the submitted guidelines.

Complete your application for health coverage online today!