Important Information Before Starting
The online enrollment web application is only compatible with
Microsoft Internet Explorer. You may download Internet Explorer by
clicking the Explorer image below.
Allow yourself plenty of time to complete the application since you will be entering detailed personal information.
Before you start, you need to have the following information available:
- You and your spouse's taxable income.
- Social Security numbers and birthdates of people in your home.
- Current or recent health insurance information.
- Identity and citizenship information, or alien registration information.
- Income information including employer name, address and phone number, of all household members who are employed.
- Amount of money received from other types of income.
- Expected date of delivery and number of babies of any pregnant household member.
- Current health insurance information for all household members with health insurance including company name, policy or group number, type of coverage, effective date, policy holder’s name and ID.
- Name, address, phone number, date of birth, and Social Security Number of the absent parent(s) for any child applying for benefits whose mother or father is not living in the household.
You will have a chance to review your information and make changes before submitting the application.
If you need more help, please call (800) 987-7767.
How To Use
- In order to save an unfinished application and return to it, you must create a user account. You will be able to do this once you start your application. You may also use your account to check the status of your application, report any changes, or resubmit your application.
- To navigate through the website, use the 'Previous' and 'Next' buttons that are located at the bottom of each screen. Do not use the 'Back' button in the browser, and do not do a screen refresh.
- To use the 'Page-level Help' feature on each page, you must turn off your pop-up blocker.
- Your session will time out after 30 minutes of inactivity. To make sure you do not time out of the application, you must make a keystroke or click the mouse anywhere on the page before 30 minutes pass.
- Some pages in the application may not display or work correctly in browsers other than Internet Explorer (IE 6, 7, or 8). For best results it is recommended that you download and use Internet Explorer.