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Documents needed to confirm your eligibility for a Qualified Health Plan (QHP)

The links below highlight the documents needed to support your application and confirm eligibility:

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Qualifying
Proof-Active

Proof of Eligibility for Financial Help

Your eligibility for financial help from Access Health CT might be affected if:

  • your income has changed since you enrolled in your current healthcare coverage
  • you didn’t give consent for us to verify your income with the IRS
  • you didn’t file taxes last year

If any of the above happened, please provide the following documents so we can determine whether or not you are still eligible for financial help:

  1. Your most recent completed, signed, and filed Federal Tax Return (IRS Form 1040 pages 1 and 2)
  2. IRS Form 8962 (from the same year as your Form 1040)
  3. One of the following to verify that you filed your taxes with the IRS:
    1. copy of certified mail or return receipt
    2. copy of e-mail confirmation of electronic filing
    3. copy of proof of mailing
For information about IRS Form 8962 please visit IRS website:
https://www.irs.gov/forms-pubs-search?search=8962

How to Submit Documents

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Sample Employer Statement SP

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    Sample Attestation of Non Income Form SP

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      Sample Affidavit of Identity Form Individual SP

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        Sample Affidavit of Identity Form Child SP

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          Sample W-2 SP

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            Sample 2017 Schedule E SP

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              Sample 2017 Schedule C SP

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                Sample 1040 SP

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                  Sample 1040

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