Health Insurance Marketplace Application for Single Health Coverage and Help Paying Costs (Short Form)
April 30, 2013
The document will be used by individuals applying for single health insurance coverage through state health insurance exchanges starting in October 2013. After completing the three-page application, the applicant will be presented with a range of health plan options, including plans in the Health Insurance Marketplace, Medicaid, the ChildrenÂ’s Health Insurance Program (CHIP) and tax credits that will help pay for premiums.
Download the Report
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