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Get Eligibility For Sliding Scale Cost Sharing
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How to fill out the Eligibility For Sliding Scale Cost Sharing online
This guide provides a comprehensive overview of how to complete the Eligibility For Sliding Scale Cost Sharing form effectively. By following these steps, you can ensure that your application is accurately submitted for cost-sharing benefits.
Follow the steps to fill out the form thoroughly
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by reviewing the form and familiarizing yourself with its structure. Ensure you have your most recent tax return ready for reference.
- Fill in your personal information as requested at the top of the form. This typically includes your name and contact details.
- Indicate your household income by reporting the amount shown on Line 7 of your IRS Form 1040 or the equivalent line on any applicable tax return. Ensure accuracy to avoid delays in processing.
- Select your preferred health insurance coverage option, either individual or family. Base your selection on your household situation.
- Review the sliding scale cost-sharing percentages associated with your household income range. This information is crucial for understanding your potential subsidy.
- Sign the authorization section at the end of the form, confirming that the information provided is accurate and that you are aware of the verification process.
- After completing the form, attach a copy of your most recent tax return and ensure all documents are organized. Confirm that no photocopies will be made of your tax return.
- Submit the completed form along with your tax return to the Office of Human Resources. Ensure you do this within the designated open enrollment period.
- Once submitted, keep a copy of your completed form for your records. You may need to refer back to this in future applications.
Complete your sliding scale cost-sharing application online today to benefit from potential health insurance subsidies.
Eligibility and Cost Family ContributionsMonthly Income by Family Size* (Effective for applications received on or after 2/18/2024) 12 Free Insurance $2,787 $3,782 $15 Per Child Per Month (Maximum of $45 per family) $3,138 $4,259 $30 Per Child Per Month (Maximum of $90 per family) $3,765 $5,1103 more rows
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