Formas y documentos (Inglés)
Aplicación para una cobertura de salud
Aplicaciones con ayuda financiera (APTC)
Large Print Application (English)
Large Print Application (Spanish)
Aplicaciones sin ayuda financiera
Large Print Application (English)
Large Print Application (Spanish)
Formularios para quejas y apelaciones
Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination
Solicitud para corregir o disputar los formularios de impuestos
Covered California Complaint Form
Bilingual Services Complaint Form
Privacy Complaint Form by a Parent, Guardian, or Authorized Representative
Privacidad
Authorization For Release of Personal Information & Appointment of Representative
Authorization For Release of Personal Information & Appointment of Representative
Courtesy Notification of Deceased
HBEX 1000: Opt Out of the Healthcare Evidence Initiative
Notification of Deceased by an Estate Representative
Notification of Deceased by an Enrolled Member
Privacy Complaint by a Representative Form
Request for an Accounting of Disclosures of Your Personal Information
Request to Amend Personal Information
Request to Amend Personal Information by a Representative
Servicios bilingües
Bilingual Services Information
Bilingual Services Complaint Form
Bilingual Services Complaint Form (Spanish)
Bilingual Services Policy (Spanish)
Hojas de datos
Coverage Options Fact Sheet (Spanish)
Health Plan Names, Plan Name on ID Card and Provider Directory Reference Guide
Medicare and Covered California Fact Sheet
Medicare and Covered California Fact Sheet (Spanish)
Rights and Protection Brochure
Información acerca de la forma 1095-A / 3895
Read About IRS Form 1095-A and 3895
COBRA
Federal COBRA Election Form for Group Health Coverage
Tabla del nivel federal de pobreza (FPL)
No discriminación
Información personal
Request to Amend Personal Information
Formas de auto certificación y determinación de elegibilidad
Attestation of Income, No Documentation Available
Attestation of Non-Incarceration Status
Attestation of Medicare Eligibility and Enrollment Status
Medicare Attestation Form (Spanish)
Solicitud de la mesa de voceros
Protección al consumidor
Consumer Protection Fact Sheet
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