Jackson Hospital | Partners | Late Fall 2016

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Employer and income information for every
member of your household (for example, from
pay stubs or W-2 forms—wage and tax statement).
Your best estimate of what your household income
will be in 2017.
MARKETPLACE APPLICATION PROCESS
Information about your household size. Figure out
who in your household should apply before you
start your application.
Home or mailing addresses for everyone applying
for coverage.
Information about everyone applying for cover-
age, like Social Security numbers and birth dates.
Information about the professional helping you (if
you’re getting help completing your application).
Document information for legal immigrants. More
information is available online.
Policy numbers for any current health insurance
plans covering members of your household.
A completed Employer Coverage Tool for every
job-based plan you or someone in your household
is eligible for. (You’ll need to fill out this form even for
coverage you’re eligible for but don’t enroll in.)
Notices from your current plan that include
your plan ID, if you have or had health coverage
in 2016.
HEALTH
PLAN
HELP
OPEN ENROLLMENT
When you apply for or renew your coverage in the
health insurance marketplace, you’ll need to provide
some information about you and your household, in-
cluding income, any coverage you currently have
and some additional items. Use the checklists below
to help you gather what you need to apply for cover-
age. Stay up-to-date about the marketplace. Visit
www.healthcare.gov to get email or text updates
that will help you get ready to apply or renew.
Thursday, December 15: Last day to enroll in or
change plans for coverage to start January 1, 2017.
Sunday, January 1: 2017 coverage starts for those
who enroll or change plans by December 15, 2016.
Tuesday, January 31: Last day to enroll in or
change a 2017 health plan. After this date, you
can enroll or change plans only if you qualify for a spe-
cial enrollment period.
DATES TO NOTE
CHECKLIST
TAX CHECKLIST
What you need
to know for 2017
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These local resources can
also help: The Wellness
Coalition, 334-293-6502,
;
and Health Services,
Inc., 334-420-5001,
.