Verify your premium assistance

Secure your financial assistance by confirming your insurance premium information

If you have been asked to verify your insurance information or premium amount to complete your application, you can use this form to submit your documents for premium verification.

Before you start:

  • Make sure you have your insurance information ready.

You will also need to attach a digital copy of one of the following:

  • Social Security Administration benefit verification letter
  • Paystub(s) for one whole month
  • Insurance statement
  • COBRA coupons
  • Insurance statement/bill from educational institutions

Note: Your privacy is important to us. Your personal information is used for internal purposes only and will never be shared. Read our privacy policy.