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general account information

FIRST NAME:​
ADDRESS:
STATE:
DATE OF BIRTH:
ANNUAL INCOME:
GENDER:
Male
Female
LAST NAME:​
CITY:
ZIP CODE:
SOCIAL SECURITY:
EMAIL:
SECURITY QUESTION:  FAVORITE FOOD
Congratulations...on completing the initial application process.  This attempt is more than just providing information, it is one step closer toward ensuring healthcare security for oneself and oneself family.  There is no other way to explain.  In our opening, we stated "Life is Complex", which is our way of identifing with others and the bigger picture beyond healthcare.  The information provided is used to determine the eligibility of an applicant to participate in the (HIX) public healthcare exchange and is "confidential" (Personal Information, Social Security#, Annual Income) becoming an official matter of record in authenticating the applicant's identity in order to receive a final determination.  (Participation Approval, Financial Aid and or Medicaid Approval)  After completing all questions and submitting information, final results will be shown along with options.  Then shop through the selection of healthcare insurance plans offered.
In Conclusion...upon receiving a final determination, there may be an additional financial award revealed in the form of "Tax Credit" (APTC) or "Cost-Sharing Reduction" (CSR) based upon personal information provided in accordance with the federal guidelines that outline income limitations and immigration status.  Some additional aid may be provided to further assist both the individual and small businesses to assist with covering their monthly insurance premium and with the following:  
  • ​Insurance Co-Payment & Co-Insurance
  • Physician Office Visit 
  • In-Patient Hospital Stay
  • Prescription Drug Cost
IMPORTANT NOTE:
​If Medicaid is offered as an option of choice, please record the assigned reference number shown and go to the local Medicaid office with the provided reference number.  There are two possible options that an applicant may have to choose between in addition to receiving a "Tax Credit"..."Medicaid" or "Cost-Sharing Reduction", but not both.  If qualified for "Cost-Sharing Reduction", the extra out-of-pocket savings can be applied toward "Silver Category" plans only and will be lost if used for any plan outside of a "Silver" selection.  Premium "Tax Credits" can be used for a plan in any category.​
For More Details

to submit an official request and apply for healthcare coverage now:

Send Application

to review eligibility, approval and final determination:

Proceed Forward