Individual Coverage What is needed for Individual Coverage? Gather details about your household, income, health status, and coverage preferences Review and comparison of Marketplace/ACA, private insurance, and healthshare options Helps match plans to your budget, preferred doctors, and prescription needs Addresses unique health factors for you and your family All personal information is confidential and used only for personalized recommendations Individual Coverage Questionnaire Updates First NameLast NameEmailPhoneZip CodeCountyDate of BirthAre you a tobacco user? Yes NoSex Female MaleAre you pregnant? Yes NoWhat is your current health insurance coverage?– Select –Employer coverage through spouseEmployer coverage through selfACA Marketplace planPrivate individual plan (PPO or other non-ACA plan)Under a parent’s planNo current coverageHealthshare programOtherOther type of health insurance coverageHow do you file your taxes? Jointly IndividuallyWill your spouse be included on the health insurance plan? Yes NoSpouse First NameSpouse Last NameSpouse’s Sex Female MaleIs your spouse pregnant? Yes NoSpouse Date of BirthIs your spouse a tobacco user? Yes NoDo you claim any dependents on your taxes? Yes No Dependent Information Full Name Date of Birth Tobacco User Sex -Select-YesNo -Select-FemaleMale Does anyone claim you as a dependent on their taxes? Yes NoDo you wish to apply for subsidies on the marketplace? Yes NoEstimated household income for 2026 you will be reporting on taxesPlease list the doctors that you want to make sure are in-network:Please list any prescriptions you’re taking that you want to make sure are covered:Save & ResumeSubmit
