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Note: Any packet that you request will be mailed to the name and address of the main subscriber on your account. If you want it mailed to another address, call Basic Health at 1-800-660-9840.
Not all forms are available for mailing.
English
Address Change (433.6 KB)- Authorization for Release of Information (36.1 KB)
- Basic Health Plus Application (Eligibility Review form) (469 KB)
- Birth or Adoption (272 KB)
- Declaration of Non-filing Status (65.2 KB)
- Divorce or Separation (46.4 KB)
- Family Addition (272 KB)
- Income Change (370.6 KB)
- Marriage (45.1 KB)
- Maternity Application (Eligibility Review form) (469 KB)
- Out-of-Country Spouse (21 KB)
- Permission Form (144 KB)
- Recertification (Eligibility Review form) (469 KB)
- Self-Employment/Rental Income Reporting Form (167 KB)
Spanish
- Basic Health Plus Application (Eligibility Review form) (387.2 KB)
- Birth or Adoption (298.4 KB)
- Declaration of Non-filing Status (34.6 KB)
- Family Addition (298.4 KB)
- Maternity Application (Eligibility Review form) (387.2 KB)
- Out-of-Country Spouse (21.7 KB)
- Permission Form (167.3 KB)
- Recertification (Eligibility Review form) (387.2 KB)
- Self-Employment/Rental Income Reporting Form (164.5 KB)
