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MISSISSIPPI APPLICATION FOR HEALTH BENEFITS This ...

MISSISSIPPI APPLICATION FOR HEALTH BENEFI TS (MEDICAID, CHIP, HELP PAYING COSTS FOR HEALTH INSURANCE COVERAGE) This APPLICATION is used to apply for HEALTH cover age for: Medicaid CHIP (Children s HEALTH Insurance Program) The new t ax credit th at can help pay y our HEALTH insurance premiums Pr ivate HEALTH insurance plans through a federal HEALTH Insurance Marketplace Use this APPLICATION to apply for children, pregnant women, low-income parents of children under age 18 and anyone in your family that needs to apply for HEALTH coverage. If you need assistance in completing this APPLICATION , need this APPLICATION in a language other than English, or if you are hearing or visually impaired and need special assistance, contact 1-800- 421-2408. You do not have to fill out this APPLICATION on paper. If you choose, you can apply on-line at or What you will need to apply: Social Security Numbers or document numbers for legal immigrants who need insurance, Birth dates, Employer and income information for each per son in your family with income.

• The new tax credit that can help pay your health insurance premiums • Private health insurance plans through a federal Health Insurance Marketplace Use this application to apply for children, pregnant women, low-income parents of children under age 18 and anyone in your family that needs to apply for health coverage. If you need

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medicaid.ms.gov

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medicaid.ms.gov

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medicaid.ms.gov

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medicaid.ms.gov

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medicaid.ms.gov

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medicaid.ms.gov

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