Find local help to apply for health insurance. • A tax credit that can immediately help lower your premiums for health coverage. Open enrollment for individual health coverage through the Affordable Care Act runs from November 1 through December 15. People and groups in the community offer free assistance both with the application process and with picking and enrolling in a plan. 1) ead the application carefully and complete R all information.

plying for health care coverage, but providing it can speed up the application process. We use SSNs to check income and other information to see who is eligible for help with health care coverage costs.

If you or someone you care for is in need of long-term services and supports but are unsure of where to start when searching for benefits, try the Information Referral Tool.A short questionnaire will point you toward the help you need based on your needs. What is the Health Insurance Marketplace? In which health care coverage program can my children enroll? Get Affordable Care Act info for individuals, families today. If you qualify for Medicaid or the Children's Health Insurance Program (CHIP). What might health care coverage include? Additional information may be requested by The Company. These Medicare-approved health plans are run by private insurance companies and provide benefits for hospital, doctor, and other health care provider services covered under Original Medicare Parts A and B as well as supplemental benefits that vary by plan. If you or someone you care for is in need of long-term services and supports but are unsure of where to start when searching for benefits, try the Information Referral Tool.A short questionnaire will point you toward the help you need based on your needs.

DHS does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. But, you can sign up during what are called Special Enrollment Periods anytime throughout the year, if you experience certain changes in your life’s circumstances. • If someone wants help getting an SSN, call 1-800-772-1213 or visit socialsecurity.gov (TTY users call 1-800-325-0778). APPLICATION FOR COVERAGE HEALTH CARE GENERAL LIABILITY INSURANCE, NON-OWNED AUTO AND HIRED AUTO LIABILITY INSURANCE, AND ADMINISTRATION OF YOUR EMPLOYEE BENEFITS PROGRAM LIABILITY INSURANCE This application is subject to review and acceptance by The Company and does not bind coverage. An alternative to Original Medicare and Medicare supplement insurance is Medicare Part C, or Medicare Advantage. 2) f you need help completing any part of this application, I please … PA 600 12/16 Pennsylvania Application for Beneits This is an application for cash, health care and SNAP beneits. Language assistance will be provided free of charge. What are Family Planning Services? No (Complete the uninsured section below.) Department of Human Services (DHS) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Application for Health Care Coverage CHIPcoversPAkids.com CHIP 2 2/19. What if someone in my family has a disability or a special care need? card with your application.)
Affordable quality health insurance coverage. Health Care Coverage.

Insured section Check each type of coverage that you currently have and provide a copy of the front and back of each insurance card: U.S. Veterans Administration Private insurance (Select subtype.) If you need this application in another language or someone to interpret, please contact your local county assistance ofice. Application for Health Coverage & Help Paying Costs Apply faster online at HealthCare.gov Use this application to see what coverage you qualify for • Marketplace plans that offer comprehensive coverage to help you stay well. Employer plan Affordable Care Act (ACA) plan (www.healthcare.gov) • A tax credit that can immediately help lower your premiums for health coverage. Esta es una solicitud de beneicios de SNAP, asistencia médica y asistencia monetaria. Affordable quality health insurance coverage. Application for Health Coverage & Help Paying Costs Apply faster online at HealthCare.gov Use this application to see what coverage you qualify for • Marketplace plans that offer comprehensive coverage to help you stay well. You can still get 2020 health insurance 2 ways: If you qualify for a Special Enrollment Period due to a life event like losing other coverage, getting married, or having a baby. Open Enrollment is over. An application that is not complete will slow down the process for enrollment in health care coverage if the applicant is eligible. Get Affordable Care Act info for individuals, families today. PLEASE PRINT. Health Care Coverage AppliCAtion For This application may be used by families with children or by pregnant women who apply for health care benefits under the Medicaid program or the Children’s Health Insurance Program (CHIP). How will I know if members of my family, including myself, are eligible? Still need health coverage for 2020? You can apply online at www.compass.state.pa.us PA 600 CH.1 (SG) 8/12 Health Care in pennsylvania

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