What paper work
do I need to bring in?
meeting with an in-person counselor to sign up for Health Insurance or the
Medical Expansion, bring the following information with you:
security number and birth dates of every member of the household.
number (I94) or proof of legal residency if members of your household
do not have social security numbers.
Permanent Residency Card
information for each adult in the household (contact information and
location of work site)
Email Address (if available)
and income information in the form of W2's, 2015 tax filing or
paystubs for each adult in the household.
your employer offers health insurance, but it is not affordable, you
must provide information about the health plan being offered.
is the name of your employer's health insurance plan?
much would premiums cost for you as an individual? And for family
coverage? Premium 40% of the total plan price? (The "minimum
value standard" of the plan)
in your employer's office is the contact person for health insurance
Please visit us at
5120 N. Broadway Street, 2nd floor, Chicago, Illinois 60640 or call (773)
To learn more
about insurance options, visit www.getcoveredillinois.gov
Benefits required by Law.
Services, like services or tests done at a medical center or doctor's
office that do not require you to stay overnight.
Services, like medical care given to treat a sudden or unexpected
illness in an emergency to keep you from getting worse.
like services, tests or surgery that require you to stay the night in
and Newborn Care, like services during pregnancy and after your baby
is delivered, including breastfeeding.
Health and Substance Use Disorder Services, including behavioral
health treatment, like services that improve your mental well being or
treat a mental illness or substance use problem.
Drugs, like medicines that require a prescription from a doctor.
and Rehabilitative Services and Devices, like physical therapy, which
helps you recover skills that you lost because you were hurt or
disabled, or helps you develop and maintain the skills you need.
Services, like tests you take to diagnose an illness or problem.
and Wellness Services and Chronic Disease Management, like check-ups
and screenings to help you stay healthy, and services to improve your
quality of like by preventing or lowering the effect of disease. This
includes monitoring and educating you about your treatment.
Care, including, dental and vision care for children. (dental care for
adults will be available through the Marketplace at an additional