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Free impartial assistance is offered from all Community Health Centers.

Marketplace Application Checklist

When you apply for or renew your coverage in the Health Insurance Marketplace, you’ll need to provide some information about you and your household, including income, any insurance coverage you currently have, and some additional items.

Use the checklist below to help you gather what you need to apply for coverage. Open Enrollment starts November 15, 2014 for coverage starting as early as January 1, 2015. Open Enrollment ends February 15, 2015.

  • Home and/or mailing addresses for everyone applying for coverage.
  • Social Security Numbers.
  • Document information for legal immigrations. Visit HealthCare.gov/help/immigration-document-types for more information.
  • Employer and income information for every member of your household (for example, from pay stubs or W-2 forms—Wage and Tax Statements).
  • Your best estimate of what your household income will be in 2015.
  • Policy numbers for any current health insurance plans covering members of your household.
  • A completed “Employer Coverage Tool” for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.)
    Visit HealthCare.gov/downloads/employer-coverage-tool.pdf to view or print the tool.
  • Notices from your current plan that include your plan ID, if you have or had health coverage in 2014.

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