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This form may be temporarily unavailable between 11 p.m. – 4 a.m. November 29-December 1.

MNsure Account Request Form

To complete this online form, you will need to enter your legal signature using a mouse or touchpad. If you prefer to complete and mail us a paper form instead, download a PDF version in English, Hmong, Somali, Spanish, Russian or Vietnamese.

MNsure’s Accessibility & Equal Opportunity (AEO) office can provide information in accessible formats for individuals with disabilities. Additionally, the AEO office can provide information on disability rights and protections to access MNsure programs. The AEO office can be reached at 651-539-2099 or 855-366-7873 or AEO@MNsure.org.

Call 651-539-2099 or 855-366-7873 for help in your language or to get contact information for a MNsure-certified assister who speaks your language.