Enrollment Trigger Enrollment Trigger: To enroll outside the Open enrollment you need a special qualifying life event within 60 days. Qualifying life events are loss of employer coverage, move into a different region ,birth, marriage, death, loss of Medical and other. Please contact us with questions at info@solidhealthinsurance.com*---2020 Open EnrolmentLoss of Employer CoverageMove to/within CaliforniaMarriage/Domestic PartnershipBirthOther Date of Event:* 1. The Basics Name : * Enter your full name Email :* We send confirmation of Enrollment to this Email Enter a valid email Phone Number :* Address - Residence : * the topic of your message City :* Zip Code :* Address - Mailing if different:* Enter a brief message 2. Household Household includes all members that file taxes together on on 1040 tax form in the current year. Number of Family Members :* 3. Tax Status How does household file taxes? *---SingleHead of HouseholdMarried Filing JointlyMarried Filing Separately Do you plan to file for this year and next? * YesNo 4. Eligibility Are you offered Affordable health insurance through an Employer? * YesNo Is everyone a US Citizen? * YesNo For non-US-Citizen list members, document type ID# , expiration date and card id # * Does any member have Medicare? * YesNo Is any member Disabled? * YesNo Medical expenses in past 3 months? *YesNo Member of a Federally Registered Indian Tribe? * YesNo Any children in foster care? * YesNo Are any children full time students? * YesNo Is any member pregnant? * YesNo Is any member involved in a lawsuit? * YesNo 5. Income Best household Estimate for 2020 Income? * Income Breakdown :* Please type your income for example Person A self- employed writer $ 30,000 Person B - W2 employee $ 575 per week employer ABC company - 123 George # Ave Los Angeles CA 90005 6. Plan SelectionYou can run your quote HERE. Make sure to put in income estimate and select "On Exchange" to see tax credit effect. Carrier * ---Anthem Bluecross of CaliforniaBlue Shield of CaliforniaChinese Community Health PlanHealth NetKaiser PermanenteL.A. Care Health PlanMolina HealthcareOscar Health PlanSharp Metal Level *---CatastrophicBronze 60Bronze HDHP (HSA)SilverGoldGold Copay (Kaiser Only)Platinum Network *---PPOEPOHMO Dental (if enrolling) Carrier *---Access Dental PlanAnthem Blue CrossCalifornia Dental NetworkDelta Network of CaliforniaDental Health ServicesLiberty Dental PlanPremier Access 7. Almost Complete! Covered California requires that your identification has been identified. Please upload a Driver License, CA ID or passport picture *---Upload official Picture ID of main applicantReceive 4 identify questions by secured email Upload copy of official picture ID (DL, State, passport, etc) E-Signature * We do not share, sell, or give your information to ANY company or person. This information is used solely to enroll you in Covered California's CALHEER's system. Important items before signing: 1. Rates are standardized for Covered Ca plans so these are the best rates available with full tax credit based on your submitted information. 2. As Certified Covered California agents, there is no cost for our service. We can help you throughout the year with your account and coverage. 3. There is no obligation with online app submittal. Simply do not pay first month's premium to cancel the policy never effective. The first payment activates the policy. 4. Covered California checks other agencies' computer records to verify citizenship, satisfactory immigration status, tax information, and other information related only to eligibility to see if you and other people on this application qualify for health insurance. 5. Covered Ca partners with Experian for indentity verification. Experian will use information from other agencies to help check your identity. This information will never be presented to outside parties. This information will not affect your credit score. The report will be called "CMS Proofing Services" and will be taken off your Experian consumer report after 25 months. 6. The 4 identity verification questions will be emailed to you securely or a representative will call to complete this step. 7. Your signature is consent to access your identity information through the Federal Data Services Hub Remote ID Proofing Service. By signing, you agree to these terms and conditions. Today's Date * Effective Date Rules: For loss of coverage, we can enroll any day prior to the 1st and still get the first. For example, we can enroll on March 30th and get April 1st. For other qualifying events (move, marriage, birth, etc), Enrollment from 1st to 15th of the month will result in following 1st of the month. For enrollment from 16th through month's end, effective date will be one month after the following 1st. For example, Enrollment on March 25th, Effective date will be May 1st. Please email at help@calhealth.net with any questions. For applications submitted on 15th or final day of month, we will make every attempt to complete but cannot promise enrollment. What to Expect: Email Confirmation – Usually received within 24 hours (business hours 9am-5pm Monday-Friday) of completed application with plan, rate, and effective date. Covered California Confirmation by Mail – Usually within 5 business days from email confirmation 1st Invoice from Carrier – Usually within 5 days of Covered Ca letter