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Verify Your Eligibility

If you received a letter from us asking you to submit documents to confirm your eligibility for healthcare coverage, follow the steps described below. Even if you have enrolled and started using your plan, you may lose your coverage or financial help if we don’t receive these documents from you by the deadline indicated in the letter.

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

Please select a category below:

Proof of Income Button Image
Identity Button Image
US Citizenship Button Image
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Sample Employer Statement SP
Haga clic aquí para descargar un Formulario de Declaración del Empleador, que puede completar en su computadora o dispositivo móvil.

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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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