Health Insurance Application Forms by State

Health Insurance is a type of insurance that covers a policyholder’s medical expenses. Insurance coverage of this type can include surgical expenses, dental expenses, and some other types of expenses dedicated to medical issues such as disabilities, illnesses, traumas, accidents, etc.

How to Apply for Health Insurance?

To get health insurance an applicant needs to conduct research and choose a plan from the variety of options offered on the market. Plans can differ from each other depending on the initial payment and cases that they cover. There can also be different limitations and circumstances when the insurance will be invalid. After a filer chooses their plan they need to fill out a Health Insurance Application.

State Health Insurance Application Forms

An Application for Health Insurance is a document that a prospect policyholder must fill out in order to apply for health insurance. Most of them require an applicant to provide information, such as their full name, social security number, current address, data about members of their household, information about their job and income, etc. In most states, the applicant can submit their application by mail or online.

The content of the application also depends on the state where it was released, since states can add some unique features to them. Select your state from the list below to file a Health Insurance Application Form and apply for your state's health care coverage.

AlabamaHawaiiMassachusettsNew MexicoSouth Dakota
AlaskaIdahoMichiganNew YorkTennessee
ArizonaIllinoisMinnesotaNorth CarolinaTexas
ArkansasIndianaMississippiNorth DakotaUtah
ColoradoKansasMontanaOklahoma (federal form)Virginia
DelawareLouisianaNevadaPennsylvaniaWest Virginia
FloridaMaineNew HampshireRhode IslandWisconsin
GeorgiaMarylandNew JerseySouth CarolinaWyoming

Health Insurance Marketplace Application

Fill out the Application for Health Coverage & Help Paying Costs to apply for Health Insurance Marketplace coverage with the Department of Health and Human Services (DHHS). The form requires information about yourself and the members of your household, including employment history, income, and insurance you currently have.

The amount of assistance and the type of program you qualify for will be decided by the DHHS based on the number of your dependents and your income.

Check out these related forms and topics:




  • Default
  • Name
  • Form number
  • Size

This form is used for employers in Alaska to notify the insurance company about their insurance coverage. It provides important information about the employer's insurance policy.

This form is used for enrolling or making changes to active group life insurance and accidental death & dismemberment (AD&D) coverage in Alaska.

This Form is used for filing an Access Florida Application in the state of Florida. It allows individuals to apply for various assistance programs offered by the Department of Children and Families, such as food assistance, cash benefits, and medical coverage.

Loading Icon