COVERED CA ENROLLMENT WITHOUT THE PHONE CALLS!

Covered CA Pandemic Special Enrollment Period Is Still Available! Apply now if you haven't before the deadline!

THE EASY 5 MINUTE HEALTH INSURANCE APPLICATION. NO PHONE CALL NEEDED!

You are one step from new coverage. We work with every carrier in the state and will place you in the best option in your situation. Our goal is to place you in a $0 premium plan. Please answer the questions below:

First Name *

Last Name *

Email *

Phone *

Address

Street Address *

City *

State *

Zipcode *

Social Security Number *

Date of birth *

Your Gender *

Male

Female

Marital Status *

Single

Married

Spouse First Name *

Spouse Last Name *

Spouse Date of Birth *

Spouse Gender *

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Male
Female
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Spouse SSN *

Does Spouse Smoke? *

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Yes
No
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Enroll Spouse *

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Yes
No
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Do you smoke? *

Yes

No

US Citizen? *

Yes

No

How many Tax dependents do you claim? *

None

1

2

3

4

5 +

Dependent 1 First Name *

Dependent 1 Last Name *

Dependent 1 Date of Birth *

Dependent 1 Gender *

Male

Female

Do they smoke? *

Yes

No

Enroll this Dependent? *

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Yes
No
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Dependent 2 First Name *

Dependent 2 Last Name *

Dependent 2 Date of Birth *

Dependent 2 Gender *

Male

Female

Do they smoke? *

Yes

No

Enroll this Dependent? *

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Yes
No
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Dependent 3 First Name *

Dependent 3 Last Name

Dependent 3 Date of Birth *

Dependent 3 Gender *

Male

Female

Do they smoke? *

Yes

No

Enroll this Dependent? *

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Yes
No
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Dependent 4 First Name *

Dependent 4 Last Name *

Dependent 4 Date of Birth *

Dependent 4 Gender *

Male

Female

Do they smoke? *

Yes

No

Enroll this Dependent? *

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Yes
No
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Dependent 5 First Name *

Dependent 5 Last Name *

Dependent 5 Date of Birth *

Dependent 5 Gender *

Male

Female

Do they smoke? *

Yes

No

Enroll this dependent? *

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Yes
No
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List any additional Tax Dependents (If you have any)

Are you currently employed? *

Yes

No

Name of your Employer *

Does Employer Offer Health Insurance? *

Yes

No

Are you self employed? (Non W2 Employee) *

Yes

No

Projected Annual Income *

$14,000-$22,000

$23,000-$30,000

$31,000-$50,000

$51,000-$60,000

$61,000+

Less than 14k per year (I don't qualify for ACA health insurance)

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Authorization and Consent Form

I give my permission to Health Mutual Network to serve as the health insurance Agent or broker for myself and my entire household, if applicable, for purposes of enrollment in a Qualified Health Plan offered in Covered California. By consenting to this agreement, I authorize the above-mentioned Agent or Agency to view and use the confidential information provided by me in writing, electronically, or by phone only for one or more of the following:

Searching for an existing Covered California application

Completing an application for eligibility and enrollment in a Covered California Qualified Health Plan or other government insurance affordability programs, such as MediCal and Emergency MediCal, or advanced tax credits to help pay for Covered California premiums

Providing ongoing account maintenance and enrollment assistance, as necessary

Responding to inquiries from the Covered California regarding my application

I understand that Health Mutual Network will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII is kept private and secure when collecting, storing, and using my PII for the stated purposes above.

I confirm that the information I provide for entry on my Covered California eligibility and enrollment application will be true to the best of my knowledge.

I understand that I do not have to share additional personal information about myself or my health with my Agent beyond what is required on the application for eligibility and enrollment purposes. I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by contacting my Agent.

Agent or Agency Name: Health Mutual Network Insurance Solutions LLC

Agent or Agency Phone Number: 323-844-8471

Agent or Agency Email: info@healthmutualnetwork.com

Agent or Agency NPN: 21178170

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Top 4 Things To Know About Covered California

What Is Covered California?

The Covered California Health Exchange is the government agency offering subsidized Obamacare plans for this state. The California Health Exchange was created to assist citizens and legal residents with applying for marketplace coverage in order to comply with the Affordable Care Act (“ACA”). When the law was passed in 2010, each of the 50 states had to decide to either create a state-run health insurance exchange or offer enrollment through a federally-operated exchange. This state chose to create their own exchange and called it “Covered California”.

What Does The California Health Exchange Do?

The Exchange helps Californians comply with the Obamacare mandate. It helps individuals and families obtain health coverage that includes the minimum essential benefits required by the law. Certain carriers are certified to offer subsidized Obama Care Plans and Prices plans and dental plans through the Exchange. These Covered California plans can sell insurance on or off the Exchange. But for qualified consumers, rates can be better if the medical plan is purchased through the marketplace.

What is the CA Tax penalty?

The “mandate” refers to the federal law that requires all Californian citizens and legal residents to have qualified medical insurance. This medical coverage may be acquired off-exchange or through Covered California. The mandate is also known as the Affordable Care Act, or Obama Care Obamacare ensures all Americans in California can get health insurance and can access medical care without having to pay a lot of money in the process. It is mandatory that everyone gets health insurance in California, and you might be subjected to a penalty if you don’t.

Can I qualify for a $0 premium plan?

There are $0 plans available now in CA for those who qualify! This is based on income, household size, zip code, and age. If you think you don't qualify, try applying again! It really doesn't hurt to see if you do. A lot of people who do not think they qualify end up qualifying and getting free insurance. Fill out our easy step process to see if you do qualify for free healthcare!

Hear From Our Happy Clients About Covered California

From finding the right plan to saving on premiums, our clients share their journeys of securing health coverage through Covered California. See how we've made a difference in their healthcare experiences and how we can help you too.

This form is to be used to help you insure you and your family. The information provided must be accurate for the subsidies to be accurate. Our job is impossible with incorrect information. Submitting this form tells us that to the best of your knowledge all of the above information is accurate. You will not receive any phone calls from Health Mutual Network. We will however text or email you if Covered CA requests anything from you. You will also receive everything in the mail. Let us know if you need any further assistance.

Need Help? You can email us at info@healthmutualnetwork.com or call us at any time at (818) 388-9192 to speak to a live specialist at no cost.