Review the Summary to make sure the information is accurate and complete. Check for duplicate or missing information.
Click the Print link to print a copy.
Click the "Change" or "Remove" link at the end of any line to make edits.
Important: After the application is electronically signed and submitted, changes can only be made by contacting the MNsure Contact Center, the Department of Human Services (DHS) or your county or tribal agency, depending on which program you are eligible for.
On the signature page, enter assister information, if applicable. If you are working with a MNsure-certified assister, such as a navigator or broker, the assister will give you the required information to enter.
Each year, MNsure renews eligibility for help paying for health coverage. MNsure needs consent to use income data, including information from tax returns to renew coverage.
Here you can consent to sharing your income information for future years to determine eligibility. If you do not give consent to use this information, your coverage cannot be renewed. Consenting to sharing this information does not mean your coverage will be automatically renewed. You can change your consent at any time.
It is important you follow all renewal instructions you receive from your program or plan. This information can come from MNsure, the Department of Human Services (DHS), your county or tribal agency, depending on the program you are enrolled in.
In the signature portion, you mush click to open and review all notices, including the Notice of Rights and Responsibilities, before entering your electronic signature.
Enter your name EXACTLY the way you entered it in the Applicant Details section.
Do a final review and confirm you are ready to submit your application. After submitting, you can only make changes by contacting the MNsure Contact Center, Department of Human Services (DHS), or your county or tribal agency, depending on which program you are eligible for.