Application for Individual Coverage

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you're ready to apply for one of our individual and family plans, use this application.

Found one of our individual and family plans that's right for you? Although applying online is usually the best way to sign up, you may be able to use this paper application to apply. Here's how to get started.

What to do:

First, make sure you can buy a plan. You can only do this:

  • During open enrollment. For 2017, open enrollment is Nov. 1, 2016, to Jan. 31, 2017.
  • If you've had certain changes in your life circumstances that mean you're eligible for special enrollment.

Second, check to see if you're eligible for a subsidy. That's financial assistance many people can get from the government that lowers the cost of your plan. When you're shopping for plans, you'll be able to see if you qualify for lower costs

If you're not eligible for a subsidy, you can apply online or use this application to apply for any of our 2016 plans except multi-state plans.

If you want to apply for a plan using a subsidy or a multi-state plan, please apply online or call a health plan advisor at 1-855-237-3501.

What you'll need:

  • Social Security number or tax ID number and date of birth for everyone who'll be covered by the plan
  • A credit card if you want to make your first payment that way
  • A printer to print the form 
  • An envelope and postage to mail the form

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