Plans for Individuals and Families
Plans for Year
2018

Your location

What kind of coverage?


Who will be covered?

Primary Applicant

(MM-DD-YYYY)

Spouse or Domestic Partner remove

(MM-DD-YYYY)

Child remove

(MM-DD-YYYY)

Requested Coverage Effective Date:


  • Your actual effective date may be different from your requested effective date. Your actual effective date is subject to you meeting the regulatory requirements for a "Special Enrollment Qualifying Event." In order to qualify for a "Special Enrollment," you must show proof of your qualifying event (e.g., if your qualifying event is a marriage, you must provide a copy of your marriage license, etc.). You must submit all supporting documentation WITH your application. Applications submitted without appropriate documentation cannot be processed. All documents (application and supporting documentation) must be submitted at the same time and through the same method (online application, envelope/email/fax). If supporting documentation is sent separate from the application there is no guarantee that it will be matched to the application.