Get Ky Application For The Kentucky Health Insurance Premium Payment (khipp) Program 2011-2025
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How to fill out the KY Application For The Kentucky Health Insurance Premium Payment (KHIPP) Program online
This guide provides clear instructions on completing the KY Application For The Kentucky Health Insurance Premium Payment (KHIPP) Program online. Follow the steps outlined below to ensure your application is filled out accurately and efficiently.
Follow the steps to successfully complete your application
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill out questions 1-5 with the applicant's personal information. Ensure to include your full name, Social Security number, address, area code and phone number. If you wish to receive email notifications, check the box and provide your email address and signature.
- Select the type of policy coverage you have by checking one of the options: Individual, Individual + Child(ren), Individual + Spouse, or Family.
- Indicate how premiums are paid by checking the appropriate box: Insured pays Insurance Carrier, Insured pays Employer, or Payroll deduction.
- Select the source of your insurance plan by checking one option: Employee Group, Private, or COBRA. If you check 'Employee Group' or 'COBRA', proceed to question 14.
- If applicable, provide the name and telephone number of the employer, as well as their Federal Employer Identification Number (FEIN).
- Indicate the premium amount for your policy and specify how frequently your premiums are paid (weekly, monthly, etc.).
- List all persons in your household who have Medicaid. Include their name, Medicaid ID number, Social Security number, date of birth, medical condition, and relationship to the policyholder. Use additional paper if necessary.
- If you wish to sign up for Direct Deposit, check the box and provide your bank name, routing number, and account number. Specify the type of account and attach a copy of your voided check.
- Once all sections have been completed, check your information for accuracy. Save your changes, and download or print the form as needed.
Complete your application online today to access the Kentucky Health Insurance Premium Payment Program.
The health insurance assistance program in Kentucky, primarily encompassing the KHIPP Program, aims to provide financial aid for health insurance premiums. This program is designed for low-income individuals and families, helping them maintain essential healthcare coverage. For further information on how to access this assistance, refer to the KY Application For The Kentucky Health Insurance Premium Payment (KHIPP) Program and make use of the resources available on uslegalforms.
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