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Instructions cover privacy, required enrollment steps, payment handling, where to submit the signed application, and multiple ways to get free assistance by phone, online, or in person.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/application-for-private-health-insurance-non-subsidized-app-form-english/302201/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/application-for-private-health-insurance-non-subsidized-app-form-english/302201.png","ImageObject",442,249,{"name":88,"@type":89},"\tCallum ","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is this application for?","Question",{"text":108,"@type":109},"It is an application for private health insurance through Covered California, helping individuals and families see their available choices and apply.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Do I need to use a different application if I may qualify for free or low-cost programs?",{"text":113,"@type":109},"Yes. If you think you qualify for free or low-cost insurance (such as Medi-Cal), low-cost pregnancy-related coverage through AIM, or help paying for insurance, you must use a different application called the “Application for Health Insurance.”",{"name":115,"@type":106,"acceptedAnswer":116},"Where do I send my completed application?",{"text":117,"@type":109},"Send the completed and signed application to Covered California, P. O. 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With insurance, you’ll know you and your family can get health care when you need it.  \nuse this Application for Private Health Insurance to see what choices you have through Covered California.  \n􀂨 You can use this application to find affordable health insurance for anyone in your family, even if you or they already have insurance.  \nIf you think you might qualify for (1) free or low-cost insurance, such as Medi-Cal,(2) low-cost insurance for pregnant women through the Access for Infants and Mothers (AIM) program, or (3) help paying for insurance, you must use a different application, called the “Application for Health Insurance.” You can get a paper application or apply online [at](at CoveredCA.com)[ CoveredCA.com](at CoveredCA.com).  \nCall: 1-800-300-1506 (TTY: 1-888-889-4500) . The call is free. You can call Monday to Friday, 8 a. m. to 6 p. m., and Saturday, [8 a. m. to 5 p. m.](8 a. m. to 5 p. m. Or visit: CoveredCA.com)[ Or visit: CoveredCA.com](8 a. m. to 5 p. m. Or visit: CoveredCA.com)  \nSTATE OF CALIFORNIA Private Health Insurance Application (11/13) CCFRM 605  \nyou can get this application in other languages  \n\n| Español 1-800-300-0213 |\n| --- |\n|  1-800-300-1533 |\n| Tiếng Việt 1-800-652-9528 |\n|  1-800-738-9116 |\n| Tagalog 1-800-983-8816 |\n| Heccrbq 1-800-778-7695 |\n|  1-800-996-1009 |\n|  1-800-921-8879 |\n|  1-800-906-8528 |\n| Hmoob 1-800-771-2156 |\n|  1-800-826-6317 |\n\nCall 1-800-300-1506 to get this application in other formats, such as large print.  \nthings to Know  \nwhat you need to know when you apply  \n􀂨 Social Security numbers for applicants who are U.S. citizens, or document information for immigrants with satisfactory status who need insurance. Proof of citizenship or immigration status is required only for applicants.  \n􀂨 We keep your information private and secure, as required by law. We'll use your information only to help you get health insurance.  \n􀂨 Families that include immigrants can apply. You can apply for your child even if you aren’t eligible for coverage. Applying for your eligible child won’t affect your immigration status or chances of becoming a permanent resident or citizen.  \n􀂨 If you are a federally recognized American Indian or Alaska Native who is getting services from the Indian Health Services, tribal health programs, or urban Indian health programs, you may still qualify for health insurance through Covered California.  \nApply faster online Apply online [at](at CoveredCA.com. It)[ CoveredCA.com](at CoveredCA.com. It)[. It](at CoveredCA.com. It)'s safe, secure, and fast—and you will get  \nresults sooner!  \nwhen you’re done Send your completed and signed application to:  \nCovered California  \nP. O. Box 989725  \nWest Sacramento, CA 95798-9725  \n􀂨 If you don’t have all the information we ask for, sign and send  \nyour application anyway. We can call you to help you finish your application.  \n􀂨 Do not send your health insurance plan enrollment payment with this application. Your plan will send you an invoice for the amount you owe.  \nget help with this application  \nWe're here to help you! You can get help at no cost.  \n􀂃 Online: [CoveredCA.com](CoveredCA.com)  \n􀂃 Phone: Call our Customer Service Center at 1-800-300-1506  \n(TTY: 1-888-889-4500) . The call is free. You can call Monday to Friday, [8 a. m. to 6 p. m](8 a. m. to 6 p. m)., and Saturday, [8 a. m. to 5 p. m](8 a. m. to 5 p. m).  \n􀂃 In person: We have ","cbCaidMZ08Q2CwK4","https://ap.wps.com/l/cbCaidMZ08Q2CwK4","pdf",1472121,24,"English","# Application\n## Attachments A–C\n## Frequently Asked Questions\n# Things to Know\n## What you need to know when you apply\n## Apply faster online\n## When you’re done\n## Get help with this application\n# Start application here\n## Step 1: Main contact","[{\"question\":\"What is this application for?\",\"answer\":\"It is an application for private health insurance through Covered California, helping individuals and families see their available choices and apply.\"},{\"question\":\"Do I need to use a different application if I may qualify for free or low-cost programs?\",\"answer\":\"Yes. If you think you qualify for free or low-cost insurance (such as Medi-Cal), low-cost pregnancy-related coverage through AIM, or help paying for insurance, you must use a different application called the “Application for Health Insurance.”\"},{\"question\":\"Where do I send my completed application?\",\"answer\":\"Send the completed and signed application to Covered California, P. O. Box 989725, West Sacramento, CA 95798-9725.\"}]","Application for Private Health Insurance - Non-subsidized App Form - English | PDF",1789790210,8]