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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

Proof of Identity

To verify your identity, send us any of the following documents:

Identity

Driver’s license issued by a state or territory showing either a photograph of you or other identifying information such as your name, age, sex, race, height, weight or eye color.

Sample CT Driver License can be viewed here.
School identification card that includes a photograph.
Voter registration card.
Identification card issued by the federal, state, or local government that contains a photograph. Sample Hartford ID card can be viewed here.
U.S. military card, draft record, or military dependent’s identification card.
U.S. or foreign passport, U.S. passport card (expired passport may be used), or identification card issued by a foreign embassy or consulate that contains a photograph.
Certificate of Naturalization (Form N-550 or N-570) or Certificate of U.S. Citizenship (Form N-560 or N-561).
Permanent Resident Card or Alien Registration Receipt Card (Form I-551). Sample 2017 Green Card can be viewed here.

Sample 2010 Green Card can be viewed here.

Identity 2

Sample 2017 Employment Authorization Card (EAD) can be viewed here.

Sample 2011 Employment Authorization Card (EAD) can be viewed here.

Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for healthcare coverage through the Exchange.
Native American tribal document with photograph.
For children under the age of 16:
U.S. Coast Guard Merchant Mariner card.
Finding of identity from a federal agency or state government agency including but not limited to public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified your identity.
Sample Canadian Driver’s License can be viewed here.

All documents that you submit for verification of identity must match your name and birth date and, if applicable, the name and birth date of each member of your household included on the application.

How to Submit Documents

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Sample CT Driver License

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    Sample Hartford ID Card

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      Sample 2017 Green Card

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        Sample 2010 Green Card

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          Sample 2017 Employment Authorization Card (EAD)

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            Sample 2011 Employment Authorization Card (EAD)

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              Sample Canadian Driver’s License

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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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