Print this pageBasic Health partners with many organizations around the state to help applicants and members. This page is dedicated to those community partners. The information below should help you as you assist the applicant or member. If you can’t find what you are looking for, please call 1-800-660-9840.
Income Guidelines (effective 7/1/08 - 6/30/09)
Additional Forms and Information
Income
Family Income Reporting form (225.3 KB)- Zero income statement
- Alternative Income Statement: English (28.4 KB) | Spanish (29.7 KB)
Income average summary (33 KB)- Income documentation process and table (102 KB)
- Subscriber premium rates (13.5 KB)
Miscellaneous
- Top processing delays
- Health Insurance Partnership
- Order bulk materials (not for individual use)
- Request for copy or transcript of tax (IRS Form 4506-T)
- Reassignment of Funds: English (118.5 KB) | Spanish (118.5 KB)
- Recertification
- Primary care provider or clinic choice (35.2 KB) English and Spanish
- Acceptable IRS forms or other documentation (29.5 KB)
- WAC revisions (39.5 KB)
- Permission form: English (122.4 KB) | Spanish (117.4 KB)
- Declaration of Non-filing Status: English (83.2 KB) | Spanish (88.9 KB) | Both (174.4 KB)
- Out-of-Country Spouse: English (21 KB) | Spanish (21.7 KB)
- Medicare form (54 KB)
- Spanish Medicare form (40.5 KB)
