Create Account

*Required Fields

To continue, please create an account.You will be asked to enter information for the household.

Username and Password

Must be 5-15 letters or numbers, starting with a letter.

Passwords must be 8-15 characters and include at least one uppercase character, one lowercase character, a number, and a special character from the following list: !@#$_=. Do not repeat characters more than two times (example: Passsword is not allowed). The password cannot contain the username.

User Information

Need an Email address? Create one here for free!

Verify Your Identity

Info

If you have a Social Security Number, you have to enter it. If you do not have a Social Security Number, please leave it blank.

Why do we need this information for the primary applicant?

The primary applicant is the person filling out the application.

You may be filling out the application because you are applying for coverage, or you may be filling it out for members of your household (members of your household are people who are on your tax return).

To secure the privacy of your account information, we need to verify the identity of the primary applicant. In order to do this we need you to provide your name, birthdate and if you have one, your social security number.

If you are applying for benefits for yourself and you have a social security number, you are required to provide it to receive health coverage or a tax credit to help pay for insurance.

If you are applying for benefits for your dependents only, you are not required to supply your social security number. However, if you do not supply your social security number, your application may take longer to process and delay your family enrollment in health coverage.

Please be sure to enter your social security number and birthdate accurately, because it will be difficult to edit, if you make a mistake.

Security Questions
User Acceptance Agreement

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