HTML Preview Application for Health Insurance Brochure page number 1.
Application for
Health Insurance
TM
Covered California is the place where individuals and families can
get aordable health insurance. With just one application, you’ll nd out
if you qualify for free or low-cost health insurance, including Medi-Cal.
The state of California created Covered California™ to help you
and your family get health insurance.
Having health insurance can give you peace of mind and help make it
possible for you to stay healthy. With insurance, you’ll know you and your
family can get health care when you need it.
Use this application to see what insurance choices you qualify for:
Free or low-cost insurance from Medi-Cal
Low-cost insurance for pregnant women through Access for Infants
and Mothers (AIM)
Affordable private health insurance plans
Help paying for your health insurance
You may qualify for a free or low-cost program even if you earn
as much as $94,000 a year for a family of 4.
You can use this application to apply for anyone in your family,
even if they already have insurance now.
Apply faster through Covered California
at CoveredCA.com
Or call: 1-800-300-1506 (TTY: 1-888-889-4500)
You can call Monday to Friday, 8 a.m. to 8 p.m.,
and Saturday, 8 a.m. to 6 p.m.
You can get this
application in
other languages
Español 1-800-300-0213
1-800-300-1533
Tiếng Việt 1-800-652-9528
1-800-738-9116
Tagalog 1-800-983-8816
Heccrbq 1-800-778-7695
1-800-996-1009
1-800-921-8879
1-800-906-8528
Hmoob 1-800-771-2156
1-800-826-6317
Call 1-800-300-1506 to
get this application in
other formats, such as
large print.
See Inside
Things to know 1
Application 2–19
Attachments A–F 20–28
Frequently Asked 29–33
Questions (FAQ)
Your destination for affordable
health insurance, including Medi-Cal
STATE OF CALIFORNIA Health Insurance Application
(11/13)
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CCFRM604