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My Username: __________________My Password: ____________________Application Tracking #: ____________________-129540329565step 1. Read your Eligibility Notice carefully. 00step 1. Read your Eligibility Notice carefully. To log-in to your Marketplace account or apply visit: Your Eligibility Notice tells you what type of financial assistance you qualify for. Tax credits lower the cost you pay monthly for your premium, and cost sharing reductions lower the other costs such as deductibles and copays.If your income changes, report the change in your account or contact the Marketplace Call Center. A change in income can affect the amount of financial assistance you are eligible to receive. If your income increases and you don’t report the change, you may owe money at tax time.My tax credit amount is: ___________________-12858832385step 2. Choose an insurance plan that fits your needs.00step 2. Choose an insurance plan that fits your needs.If you qualify for cost sharing reductions, you will only receive them if you choose a Silver plan.The insurance plan I chose is: My coverage start date is:___________________________________________________My health plan ID is:My health plan phone number:___________________________________________________-12382535560step 3. Know what your costs will be. 00step 3. Know what your costs will be. Premium: __________ Deductible: ___________ Out-of-pocket maximum: _______ Primary Care Co-Pay:_______ Specialist Visit Co-Pay:_______ Emergency Room Co-Pay: _______ Inpatient Hospital Co-Pay: ______ Generic Drugs Co-Pay: ______ Brand Name Drugs Co-Pay:______Coinsurance: ______%-17907045085step 4. Pay your first month’s premium to begin your coverage. You are not covered until you pay your first premium. 00step 4. Pay your first month’s premium to begin your coverage. You are not covered until you pay your first premium. Premiums must be paid on time in order to keep your coverage.-10380420320step 5. Review all of the information that your insurance company sends to you in your insurance membership package. The insurance company should have sent you proof of your insurance coverage in the form of a card. 00step 5. Review all of the information that your insurance company sends to you in your insurance membership package. The insurance company should have sent you proof of your insurance coverage in the form of a card. Your insurance card will have the phone number to call with questions about your benefits. If there are any changes throughout the year to your contact information, household members, or income, contact your insurance company and the Marketplace.-144145156845step 6. You will renew your health coverage during the next Open Enrollment Period (November 1, 2016 – January 31, 2017). 00step 6. You will renew your health coverage during the next Open Enrollment Period (November 1, 2016 – January 31, 2017). You will receive a letter with instructions on how to renew or change your plan before the next Open Enrollment Period begins.CONTACT INFORMATIONThis list of contacts will help you when you have any questions regarding your insurance plan information, how to use your insurance, your selection of in-network providers, or where to go for care.Your insurance company’s phone number/help line (also called “beneficiary line”) – This is the number you can call if you ever have a question about your insurance (you should be able to find this number on your insurance card):______________________________________If you got insurance through the Marketplace and have questions about your plan or a comparable plan, you can contact a Marketplace Call Center customer service representative at: 1-800-318-2596 or (TTY: 1-855-889-4325)If you need to schedule an exam, are unsure when you need to visit the doctor next, or have questions about your health, call your doctor at:______________________________________Remember: Your local Health Center is there to serve you. Health Centers provide education, translation, and transportation services in addition to primary care services. Contact your local Health Center if you’re looking for a quality doctor.Call 2-1-1 to find application assistance near you or if you want more information about Health Centers near you.For help understanding what to do after you apply and how to use your new coverage visit ................
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