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You could be eligible for free coverage.  \n• Families that include immigrants can apply. You can apply for your child even if you aren’t eligible for coverage. Applying won’t affect your immigration status or chances of becoming a permanent resident or citizen.  \n• If someone is helping you fill out this application, or you are applying for someone other than a spouse or family member under age 21, an authorized representative form (Appendix C) must be completed  \n• Complete Appendix F if you are applying for health coverage for someone in need of nursing facility or community-based care, who is between the ages of 19 and 64 and who is not eligible for or enrolled in Medicaid.  \n• Complete Appendix D if you are age 65 or older or disabled or any age and need assistance with nursing facility or community based care.  \n[Online:](Online: Apply at commonhelp.virginia.gov)[ Apply at](Online: Apply at commonhelp.virginia.gov)[ ](Online: Apply at commonhelp.virginia.gov)[commonhelp.virginia.gov](Online: Apply at commonhelp.virginia.gov).  \nPhone: Call Cover Virginia at 1-855-242-8282  \n• Social Security numbers (or document numbers for any eligible immigrants who need insurance)  \n• Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements)  \n• Policy numbers for any current health insurance  \n• Information about any job-related health insurance available to your family  \nWe ask about income and other information to let you know what coverage you qualify for and if you can get any help paying for it. We’ll keep all the information you provide private and secure, as required by law.  \nIf you use this paper application, send your complete, signed application to the Cardinal Care Correspondence Center (see STEP 6 for address) . They will follow up with you to obtain additional information. Your application should be processed within 45 days from the date it was received.  \n• Phone: Call Cover Virginia at 1-855-242-8282  \n• In person: There will be application assisters in your area who can help. Visit our website at [coverva.dmas.virginia.gov](coverva.dmas.virginia.gov) or call 1-855-242-8282 for more information.  \n• En Español: Llame a nuestro centro de ayuda gratis al 1-855-242-8282  \nIf you are visually impaired and need large print or other assistance to access this document, please contact us at 1-855-242-8282  \n(TTY: 1-888-221-1590) .  \nNEED HELP WITH YOUR APPLICATION? Visit [coverva.dmas.virginia.gov](coverva.dmas.virginia.gov) or call us at 1-855-242-8282. Para obtener una copia de este formulario en Español, llame 1-855-242-8282. If you need help in a language other than English, call 1-855-242-8282 and tell the customer service representative the language you need. We’ll get you help at no cost to you. TTY users should call  \n7/22/25  \n1-888-221-1590.  \nCover Page  \nIt is important we treat you fairly.  \nWe will keep your information secure and private.  \nThis agency complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This agency does not exclude people or treat them less favorably because","cbCaio8MVIPSWygG","https://ap.wps.com/l/cbCaio8MVIPSWygG","pdf",3252172,"English","# Who can use this application?\n# What you may need to apply\n# Why do we ask for this information?\n# What happens next?\n# Get help with this application\n## Cover Virginia contact options\n## Language and accessibility assistance\n## Civil rights information","[{\"question\":\"Who can use this application for health coverage?\",\"answer\":\"The application can be used to apply for anyone in a family. It can also be used even if you or your child already has health coverage, and families that include immigrants can apply.\"},{\"question\":\"What information is typically needed to apply?\",\"answer\":\"You may need Social Security numbers (or document numbers for eligible immigrants), employer and income information for everyone in the family, policy numbers for current health insurance, and information about job-related health insurance available to your family.\"},{\"question\":\"How long will processing take and what happens after submission?\",\"answer\":\"After the signed application is sent to the Cardinal Care Correspondence Center, follow-up will be conducted to obtain additional information. The application should be processed within 45 days from the date it was received.\"}]","Application for Health Coverage - Help Paying Costs | PDF",1789835681,6]