COVERED CA ENROLLMENT WITHOUT THE PHONE CALLS!

Covered CA Pandemic Special Enrollment Period Is Still Available! Apply now if you haven't before the deadline!

THE EASY 5 MINUTE HEALTH INSURANCE APPLICATION. NO PHONE CALL NEEDED!

You are one step from new coverage. We work with every carrier in the state and will place you in the best option in your situation. Our goal is to place you in a $0 premium plan. Please answer the questions below:

Just a few questions and 90% of people that fill out the form can be signed up without talking to an agent.

How many people need coverage? *

- select an option -

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Are you married? *

Yes

No

Yes I'm Married:

Spouse Name *

Does Spouse Need Coverage? *

Yes

No

Spouse Date of Birth

Spouse Social Security Number to verify citizenship

*Spouse socials are only necessary if applying. If you choose NOT to provide your Social Security Number today, you will have 90 days to provide your Social Security Number to Covered CA. If they do NOT receive your information in 90 days, Covered CA will terminate your coverage. You will get texts and phone calls once you've received your cards.

Name of Employer for Spouse *

Spouse Expected Income Per Month *

$

Do you want to apply for a subsidy to pay for your insurance? *

Yes

No

MAIN APPLICANT INFORMATION

Full Name *

Main Applicant Date of Birth

Cell Phone Number *

Email *

ADDRESS INFORMATION

Address *

City *

State *

Postal code *

HOUSEHOLD INFORMATION

Social Security (no dashes)

*If you choose NOT to provide your Social Security Number today, you will have 90 days to provide your Social Security Number to Covered CA. If they do NOT receive your information in 90 days, Covered CA will terminate your coverage. You will get texts and phone calls once you've received your cards.

Name of Your Employer *

Expected Income Per Month *

$

Do You Claim Any Dependents? *

- select -

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Please Add Info for Dependent #1

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 2nd Dependent? *

Yes

No

Please Add Info for Dependent #2

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 3rd Dependent? *

Yes

No

Please Add Info for Dependent #3

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 4th Dependent? *

Yes

No

Please Add Info for Dependent #4

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 5th Dependent? *

Yes

No

Please Add Info for Dependent #5

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 6th Dependent? *

Yes

No

Please Add Info for Dependent #6

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 7th Dependent? *

Yes

No

Please Add Info for Dependent #7

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 8th Dependent? *

Yes

No

Please Add Info for Dependent #8

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

Need to add a 9th Dependent? *

Yes

No

Please Add Info for Dependent #9

Full Name
Relationship to Applicant
Birthday
Social Security Number
Do They Need Coverage?

Socials are only needed if dependent is applying for insurance

I attest that from this day forward Health Mutual Network will be the agent of record for my Covered CA insurance plan. *

Yes

No

Do you understand that if you're not eligible for a $0 plan, we will enroll you in the cheapest plan that is still affordable? *

Yes

No

Do you currently have Medicare, Medi-Cal, an employer policy or VA benefits? (You will NOT qualify for Covered CA subsidy if you qualify for Medicare/Medi-Cal/employer or VA plan). *

Yes

No

Yes! I give Health Mutual Network permission to access my Covered CA application and submit it for a $0 premium health insurance plan!

Agreements

Please read the attestations below and sign if you agree.

I agree to have my information used and retrieved from government data sources for this application. I have consent for all people I’ve listed on the application for their information to be retrieved and used from government data sources.
I understand that I’m required to provide true answers and that I may be asked to provide additional information, including proof of my eligibility for a Special Enrollment Period if I qualify. If I don’t, I may face penalties, including the risk of losing my eligibility for coverage.

Renewal of coverage
To make it easier to determine my eligibility for help paying for coverage in future years, I agree to allow the Marketplace to use my income data, including information from tax returns, for the next 5 years. Covered CA will send me a notice, let me make any changes, and I can opt out at any time.

Tax attestation

I understand that I’m not eligible for a premium tax credit if I’m found eligible for other qualifying health coverage, like Medi-Cal, the Children’s Health Insurance Program (CHIP), or a job-based health plan. I also understand that if I become eligible for other qualifying health coverage, I must contact Covered CA to end my coverage and premium tax credit. If I don’t, the person who files taxes in my household may need to pay back my premium tax credit.
I understand that because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents: I must file a federal income tax return for this tax year.

I must file a federal income tax return for the 2022 tax year.

If I’m married at the end of 2022, I must file a joint income tax return with my spouse.I also expect that:

No one else will be able to claim me as a dependent on their 2022 federal income tax return. I’ll claim a personal exemption deduction on my 2022 federal income tax return for any individual listed on this application as my dependent who is enrolled in coverage through this Marketplace, and whose premium for coverage is paid in whole or in part by advance payments of the premium tax credit.

If any of the above changes:

I understand that it may impact my ability to get the premium tax credit.
I also understand that when I file my 2022 federal income tax return, the Internal Revenue Service (IRS) will compare the income on my tax return with the income on my application. I understand that if the income on my tax return is lower than the amount of income on my application, I may be eligible to get an additional premium tax credit amount. On the other hand, if the income on my tax return is higher than the amount of income on my application, I may owe additional federal income tax.

Sign and submit

Please read the attestations below and select a response for each statement.

I know that I must tell the program I’ll be enrolled in if information I listed on this application changes. I know I can make changes by texting Health Mutual Network at (800)825-4694. I know a change in my information could affect eligibility for member(s) of my household. help
If anyone on your application is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (like Medicare, Medi-Cal, or CHIP), Covered CA will automatically end their plan coverage. This will help make sure that anyone who’s found to have other qualifying coverage won’t stay enrolled in Covered CA coverage and have to pay full cost.
I’m signing this application under penalty of perjury, which means I’ve provided true answers to all of the questions to the best of my knowledge. I know I may be subject to penalties under federal law if I intentionally provide false information.

Agreement Attestation

Sign in Box to Submit Application

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Top 4 Things To Know About Covered California

What Is Covered California?

The Covered California Health Exchange is the government agency offering subsidized Obamacare plans for this state. The California Health Exchange was created to assist citizens and legal residents with applying for marketplace coverage in order to comply with the Affordable Care Act (“ACA”). When the law was passed in 2010, each of the 50 states had to decide to either create a state-run health insurance exchange or offer enrollment through a federally-operated exchange. This state chose to create their own exchange and called it “Covered California”.

What Does The California Health Exchange Do?

The Exchange helps Californians comply with the Obamacare mandate. It helps individuals and families obtain health coverage that includes the minimum essential benefits required by the law. Certain carriers are certified to offer subsidized Obama Care Plans and Prices plans and dental plans through the Exchange. These Covered California plans can sell insurance on or off the Exchange. But for qualified consumers, rates can be better if the medical plan is purchased through the marketplace.

What is the CA Tax penalty?

The “mandate” refers to the federal law that requires all Californian citizens and legal residents to have qualified medical insurance. This medical coverage may be acquired off-exchange or through Covered California. The mandate is also known as the Affordable Care Act, or Obama Care Obamacare ensures all Americans in California can get health insurance and can access medical care without having to pay a lot of money in the process. It is mandatory that everyone gets health insurance in California, and you might be subjected to a penalty if you don’t.

Can I qualify for a $0 premium plan?

There are $0 plans available now in CA for those who qualify! This is based on income, household size, zip code, and age. If you think you don't qualify, try applying again! It really doesn't hurt to see if you do. A lot of people who do not think they qualify end up qualifying and getting free insurance. Fill out our easy step process to see if you do qualify for free healthcare!

I can’t thank Health Mutual Network enough! I’ve always been self employed and wasn’t offered any insurance elsewhere so I was scrambling on the marketplace for an Covered CA plan. I needed to get my wife to the hospital for a procedure but the application was hard to finish. I googled some more and found Health Mutual Network's easy enrollment process. Not only did they do everything for me after filling out the form, she had major premium subsidies I didn't know we could qualify for. She has finished her final procedure and am so thankfully that it was that easy to enroll and everything ended up well.

Matt S. from Riverside, CA

I was confused on how all the insurance plans work so I decided to get a quote from Health Mutual Network for my Covered CA application. I loved that I didn't receive spam calls from so many people and it was just a no-frill enrollment process. So I end up finding out that I qualified for a $0 premium plan with more benefits than my last coverage. I was in shock! I just put my information in and in a week I received my cards and brochures. This was such a simple process and I appreciate them being upfront and easy to work with.

Tracy M. from San Francisco, CA

I am very glad that I enrolled through Health Mutual Network instead of the nightmare that was the Covered CA application. I lost my job recently and didn't have any more money to spend on the monthly payment. I finished the application through Health Mutual Network and found out I'm paying $0 for my premium. I never imagined having free health coverage. My brother has Medicare because he was disabled and it was free. I didn't know I could qualify with my income. I actually did also reach out to Health Mutual Network because I wasn't sure what document to upload. They walked me through it and it was all handled. Only good things to say about this company and their enrollment process.

Shawn H. from San Diego, CA

This form is to be used to help you insure you and your family. The information provided must be accurate for the subsidies to be accurate. Our job is impossible with incorrect information. Submitting this form tells us that to the best of your knowledge all of the above information is accurate. You will not receive any phone calls from Health Mutual Network. We will however text or email you if Covered CA requests anything from you. You will also receive everything in the mail. Let us know if you need any further assistance.

Need Help? You can email us at info@healthmutualnetwork.com or call us at any time at (818) 388-9192 to speak to a live specialist at no cost.