Set aside enough time to complete the application and enroll in a plan in one sitting. We recommend you do not save your work part way through and come back later.
An overview of what's on this application and how to navigate it online.
Information about signing into your account and choosing an application.
Entering information about the primary contact, tips and help with this section.
People to include in your household and entering information about your household.
Reporting current income for each person listed on your application.
Information about household members who have access to employer-sponsored insurance (ESI).
Reviewing your application, signing and submitting your application.
After you submit your application, you'll see the eligibility screen telling you if you qualify for financial assistance.