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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)- Basic Health Plus Application (304.2 KB)
- Birth or Adoption (352.6 KB)
- Declaration of Non-filing Status (30.8 KB)
- Divorce or Separation (978.9 KB)
- Family Addition (352.6 KB)
- Income Change (243.4 KB)
- Marriage (423.1 KB)
- Maternity (Pregnancy) Application (304.9 KB)
- Out-of-Country Spouse (21 KB)
- Permission Form (122.4 KB)
- Self-Employment/Rental Income Reporting Form (140.4 KB)
Spanish
- Basic Health Plus Application (263 KB)
- Declaration of Non-filing Status (16.5 KB)
- Maternity (Pregnancy) Application (325.1 KB)
- Out-of-Country Spouse (21.7 KB)
- Permission Form (117.4 KB)
- Self-Employment/Rental Income Reporting Form (171.7 KB)
