Health Insurance Application Forms by State
Health Insurance is a type of insurance that covers a policyholder’s medical expenses. Insurance coverage of this type can include surgical expenses, dental expenses, and some other types of expenses dedicated to medical issues such as disabilities, illnesses, traumas, accidents, etc.
How to Apply for Health Insurance?
To get health insurance an applicant needs to conduct research and choose a plan from the variety of options offered on the market. Plans can differ from each other depending on the initial payment and cases that they cover. There can also be different limitations and circumstances when the insurance will be invalid. After a filer chooses their plan they need to fill outa Health Insurance Application .
State Health Insurance Application Forms
An Application for Health Insurance is a document that a prospect policyholder must fill out in order to apply for health insurance. Most of them require an applicant to provide information, such as their full name, social security number, current address, data about members of their household, information about their job and income, etc. In most states, the applicant can submit their application by mail or online.
The content of the application also depends on the state where it was released, since states can add some unique features to them. Select your state from the list below to file a Health Insurance Application Form and apply for your state's health care coverage.
Health Insurance Marketplace Application
Fill out the Application for Health Coverage & Help Paying Costs to apply for Health Insurance Marketplace coverage with the Department of Health and Human Services (DHHS). The form requires information about yourself and the members of your household, including employment history, income, and insurance you currently have.
The amount of assistance and the type of program you qualify for will be decided by the DHHS based on the number of your dependents and your income.
Check out these related forms and topics:
- File Form CMS-1500, Health Insurance Claim Form - a form developed by Centers for Medicare & Medicaid Services and is used by patients to claim coverage of medical expenses;
- File an unemployment claim with local authorities;
- Apply for benefits with the Social Security Administration.
Documents:
109
This Form is used for single adults in Arkansas to apply for health coverage.
PDF 
Word
This Form is used for applying for health insurance in the state of Delaware.
This Form is used for providing information about the small business health insurance deduction in the state of Alabama.
This form is used for employers in Alaska to notify the insurance company about their insurance coverage. It provides important information about the employer's insurance policy.
This form is used for enrolling or making changes to active group life insurance and accidental death & dismemberment (AD&D) coverage in Alaska.
This form is used for Alabama employers who wish to apply for self insurance for workers' compensation coverage.
This Form is used to apply for health coverage in the state of Indiana.
This form is used for applying for health insurance in New York.
This document is used for applying for health coverage and financial assistance in New Hampshire.
This form is used for applying for health coverage and financial assistance for healthcare costs in the state of Virginia.
This type of document is used for applying for health coverage and financial assistance in Virginia.
This form is used for renewing the certificate of self-insurance in Alaska.
This form is used for applying for medical benefits through mail in the state of Illinois.
This Form is used for applying for services in Alaska.
This Form is used for applying for Access Florida benefits in Florida. It is a Spanish version of the application form.
This Form is used for filing an Access Florida Application in the state of Florida. It allows individuals to apply for various assistance programs offered by the Department of Children and Families, such as food assistance, cash benefits, and medical coverage.
This form is used for applying for cash, food, or medical assistance in Ohio. It is a necessary document for those in need of financial support for basic needs.
This form is used for adults and children in Alaska who need long term care.
This form is used for applying for household health coverage in Arkansas.
This document is an application form for health insurance in Colorado. It also provides assistance for paying health insurance costs.
This document is for applying for health insurance and financial assistance for healthcare costs in Colorado.
This document is used for applying for long-term care or waiver in the state of Connecticut.
This document is a Form W-1 LTCS used to apply for Long Term Care Services and Exemption in Connecticut.
This form is used for applying for the Medicaid/Medicare Buy-In program in Florida.
This form is used for applying for extended family planning benefits under health insurance in the state of Florida.
This form is used for applying for health coverage and help with costs in the state of Georgia, United States.
This Form is used for applying for health coverage and financial assistance in paying for costs in Georgia.
