Do You Qualify for Special Enrollment?
- You must give us approved proof of a qualifying event with this application.
- Without proof, we cannot process your form or sign you up for a health or dental plan.
Signing Up During Special Enrollment Period (SEP)
- An SEP is a chance to sign up outside of Open Enrollment.
- Check more than one event if more than one happened to you.
- Once your policy has been issued, your SEP proof cannot be re-used to apply for a different plan.
If You Have Questions
- Please contact us for examples of proofs we can accept.
- Details about documents you need to provide are on our help site on the Special Enrollment page.
- You can also view the list of acceptable proof.
SEP Qualifying Events
When you are signing up outside of Open Enrollment, you are signing up for coverage during a Special Enrollment Period (SEP)
New 2019 Plans and Rates
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This is the last step. You must click the SUBMIT button at the bottom of the page
Confirm and Sign
Before submitting your application, please review and verify that you agree with the statements below:
- No one applying for coverage is in jail.
- I will notify the insurer if anything on this application changes. I can do this through the federal marketplace. I understand a change could affect our eligibility for plans and subsidies.
- I give permission to the federal marketplace to access my tax returns for up to 5 years to verify my income for premium tax credit purposes. I can revoke this permission at anytime.
- I'm signing this application under penalty of perjury, which means I've provided true answers to all of the questions to the best of my knowledge. I know that I may be subject to penalties under federal law if I intentionally provide false or untrue information.
- If anyone on this application enrolls in Medicaid, I'm giving the Medicaid agency our rights to pursue and get any money from other health insurance, legal settlements, or other third parties. I'm also giving to the Medicaid agency rights to pursue and get medical support from a spouse or parent.
- If a child on this application has a parent living outside the home, I know I'll be asked to cooperate with the agency that collects medical support from an absent parent. If I think that cooperating to collect medical support will harm me or my children, I can tell the agency and I may not have to cooperate.
- I acknowledge iHealthAgents as my agent of record and authorize them to submit and sign this application on my behalf.
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Select your county
Your zip code has multiple counties. Please select the county that you live in.
Has anyone applying for coverage smoked cigarettes or used any tobacco products in the past 6 months?
The government might pay for some of your health insurance depending on your income. Do you want to see if you qualify?
Size of Household
How many people are in your taxable household?
Estimated Annual Household Income
Please provide an estimate of your adjusted gross annual income to determine whether you qualify for a premium tax credit that will reduce the cost of your health premium
You and/or your family may qualify for other assistance
We have many affordable plans for you!
You are Qualified!
The government may pay per month for your insurance.
Unable to Complete Subsidy Estimate!
There is a problem calculation your premium tax credit. You can proceed to view the plans now and check back later to determine your premium tax credit.
Or you can contact us directly and we will help find the best plan for you.
Search Doctors & Hospitals
Find out if your health care provider participates in plans' network
Save your progress
You can save multiple applications, view and edit your information on file
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Includes unlimited troubleshooting & support
Please click on CONTINUE to review and submit your application to our agents.
Without adding the information of the household members, your premium tax credit amount might change.Click here to skip this page and re-calculate your premium tax credit.
Additional Household Members
To receive your maximum premium tax credit requires information about any other members of your tax household even if they aren't applying for health insurance
New Plan Information
Optional Applicant Info
Below are some optional information for your Blue Cross Blue Shield application
The last step in completing your application is confirmation and payment
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This is the information that we will include on your application to pay your first month's premium directly to your insurance carrier. It does not include your one-time application fee.