What is the Ccfrm604 form used for?
The Ccfrm604 form is the application for health insurance through Covered California. Individuals and families can use this form to find out if they qualify for free or low-cost health insurance options, including Medi-Cal, which is designed to provide affordable healthcare to those who need it most. By completing this application, you can explore various insurance choices available to you and your family.
Who can apply using the Ccfrm604 form?
Anyone living in California can apply using the Ccfrm604 form. This includes individuals and families, regardless of their current insurance status. Even if a family member already has insurance, you can still apply for other members. Additionally, immigrant families can apply, ensuring that children can receive coverage without impacting their immigration status.
What information do I need to provide when filling out the Ccfrm604 form?
When completing the Ccfrm604 form, you will need to provide various pieces of information. This includes Social Security numbers for U.S. citizens or relevant documentation for those with satisfactory immigration status. You must also provide family income information, federal tax information, and details about any current health insurance plans covering family members. This data helps determine eligibility for different health programs and benefits.
How is my information protected when I submit this form?
Your personal information is kept private and secure in accordance with federal and state laws. The data provided in the Ccfrm604 form will only be used to assess your eligibility for health insurance options. It will not be shared or used for any other purpose without your consent, ensuring your information remains confidential.
What should I do if I don’t have all the required information?
If you are missing some of the required information while filling out the Ccfrm604 form, it is still advisable to submit the application. You can send it in with the details you currently have. After submission, Covered California may contact you to assist in completing your application. Do not worry; it’s acceptable to submit the form incomplete.
Where can I find help if I need assistance with the Ccfrm604 form?
Help is readily available for individuals needing assistance with the Ccfrm604 form. You can receive free help online at CoveredCA.com or by calling the Covered California Customer Service Center at 1-800-300-1506. Customer service representatives are available from 8 a.m. to 8 p.m., Monday through Friday, and from 8 a.m. to 6 p.m. on Saturdays. Additionally, Certified Enrollment Counselors and Certified Insurance Agents can provide in-person assistance.