Call 1-855-642-8572. Please allow three business days for requests by phone. Or send your name and phone number to [email protected] or to Maryland Health Connection, PO Box 857, Lanham, MD 20703. Someone from Maryland Health Connection will contact you by phone to complete your request. Allow up to 30 days for requests by email or mail. Medicaid enrollment is year-round. Apply at www.marylandhealthconnection.gov or download the free “Enroll MHC" mobile app. Call 855-642-8572 weekdays from 8 am to 6 pm to apply by telephone. Get connected to free expert help virtually or by telephone. Our Health Education and Advocacy Unit can assist consumers who have enrollment …How do I apply? There are several ways to apply for Medicaid coverage through Maryland Health Connection: Online at www.marylandhealthconnection.gov. …MarylandHealthConnection.gov l Visit your local Department of Social Services l Call 1-855-642-8572. Deaf and hard of hearing use Relay service l Find free, in-person help near you at MarylandHealthConnection.gov/help l Download our free mobile app, Enroll MHC What benefits are covered through Medicaid? You can apply for coverage in any of the following ways: 1) Online – Create an account, complete your application, choose a plan and enroll online. 2) In Person – Complete your application in person with free, local help. 3) Phone – Call 1-855-642-8572. Deaf and hard of hearing use Relay service. Some life events qualify you to enroll in health coverage outside of open enrollment. Want to learn more about the latest info? Get text alerts! See if you qualify to enroll in health coverage now. The application is available daily from 6 a.m. to 11 p.m.Maryland Health Connection Attn: Tax Forms P.O. Box 857 Lanham, MD 20703 Language services are available to assist you. Call 1-855-642-8572 (TTY:1-855-642-8573).AFFIDAVIT OF OTHER INCOME . Complete this Affidavit if you have no other document to show your current income or recent change in income. DATE: Affidavit of Self-Employment Income. Note: If you have operated your business for at least a year and have a signed copy of the most recent year’s Federal Tax Return including all schedules and attachments, AND you do not anticipate your income will change by more than 10 percent in the coming year, supply your complete tax return and do not ... See if you qualify to enroll in health coverage now. The application is available daily from 6 a.m. to 11 p.m. Help for Immigrant Families: Eligibility to Enroll (PDF), (Amharic), (Haitian Creole), (Vietnamese) Applying for Health Coverage: Protections for Immigrant Families (PDF) Coverage Options for Victims of Intimate Partner Violence (PDF) Health Insurance Options for Individuals with HIV (PDF) Health Insurance Options for Adults Age 65 and Older (PDF) See if you qualify to enroll in health coverage now. The application is available daily from 6 a.m. to 11 p.m. Home > Qualified Health Plan (QHPs) A QHP is an insurance plan that is certified by Maryland Health Connection. It provides essential health benefits and follows established limits on cost sharing. Finding the Right Plan with MHC. If I'm enrolled in a plan this year, do I need to shop again for next year? Maryland Health Connection is the only place to get financial help to pay for your insurance plan. Without health insurance the average emergency room visit in Maryland is $2200. Protect yourself from unexpected medical costs with health insurance. The average Maryland Health Connection customer saves $300/month. Your MCO through Medicaid covers doctor visits, pregnancy care, prescription drugs, hospital and emergency services, and more, at no cost. Visits to the doctor, including regular checkups and specialists. Pregnancy care. Family planning and birth control. Prescription drugs. Insurance brokers can help you enroll in the best private health plan to meet the needs of you and your family at no cost to you. View a map of brokers near you. Get help with Medicaid. Call 1-855-642-8572. You can also visit a local health department (PDF), department of social services or a navigator near you. 1. Aplique Medicaid o MCHP. Aplique en línea en marylandhealthconnection.gov, Aplique a través de nuestra aplicación móvil: Apple o Android. Aplique por teléfono al 1-855-642-8572. Solicite una solicitud en papel llamando al 1-855-642-8572. Infórmese acerca de a quién incluir en su hogar, cómo calcular los ingresos de su hogar y qué ... Get help • Online: MarylandHealthConnection.gov. • Phone: Call our consumer support center at 1-855-642-8572. TTY users should call 1-855-642-8573. • En Español: Llame a nuestro centro de asistencia al consumidor al 1-855-642-8572. Los usuarios de TTY deben llamar al 1-855-642-8573. • Contact a broker. What happens next? MarylandHealthConnection.gov/appeals File a complaint about the result of an appeal of a denial of coverage and/or file a complaint about a health insurance company: l Contact Maryland Insurance Administration at 1-800-492-6116 or www.insurance.maryland.govMaryland resident; Currently or recently pregnant; Income up to 250% federal poverty level (FPL). The best way to know if you can get Medicaid is to apply. Starting July 1, 2023, you can apply: Online at MarylandHealthConnection.gov. By using the app: Apple or Android . By calling 1-855-642-8572, deaf and hard of hearing use [email protected] • By Phone: Call the Maryland Health Connection at (855) 642-8572 (TTY: (855) 642-8573). *Please include your Maryland Health Connection ID# on all requests. If you disagree with our decision and want to speak to someone about it, or if you need help asking for a hearing, call (855) 642-8572 (TTY: (855) 642-8573).Online at MarylandHealthConnection.gov. Visit a local connector entity, health department or department of social services. Download the free mobile app, Enroll MHC. Call …Click Forgot Your User ID or Password on the login screen. If you do not have an email address or cell number associated with your account or have forgotten both your user ID and email call us toll-free at 1-855-642-8572. Deaf and hard of hearing use Relay. Finding the Right Plan with MHC. If I'm enrolled in a plan this year, do I need to shop ...The employee needs to fill out this section. 1. Employee name (First, Middle, Last) 2. Social Security Number. 3. List the first and last names of each person in the employee’s household and tell us if they could get health coverage through the employer named in box 4 below, even if they’re not currently enrolled.Para actualizar la información de contacto en línea, ingrese a su cuenta en MarylandHealthConnection.gov. Si necesita restablecer la contraseña de su cuenta, contáctese con nuestra asistente virtual Flora o visite el enlace en la página de inicio de sesión. 2. Manténgase atento a los comunicados de Maryland Health Connection.Affidavit of Self-Employment Income. Note: If you have operated your business for at least a year and have a signed copy of the most recent year’s Federal Tax Return including all schedules and attachments, AND you do not anticipate your income will change by more than 10 percent in the coming year, supply your complete tax return and do not ... La aplicación Enroll MHC le permite cargar documentos de manera fácil utilizando la cámara. Obtenga ayuda gratuita para cargar sus documentos a través de un asesor certificado local. Si no puede subir los documentos en línea, puede enviarlos por correo a Maryland Health Connection, Casilla Postal 857, Lanham, MD 20703. Contact a broker with questions, visit MarylandHealthConnection.gov or call us at 1-855-642-8572. TTY users should call 1-855-642-8573. Page 1 of 3 STEP 1 STEP 2 * Required Field MHC 04122614. STEP 3 For certified application …You can apply for coverage in any of the following ways: 1) Online – Create an account, complete your application, choose a plan and enroll online. 2) In Person – Complete your application in person with free, local help. 3) Phone – Call 1-855-642-8572. Deaf and hard of hearing use Relay service.Welcome to HealthChoice Maryland Medicaid's managed care program. Find information for Medicaid members and providers. Understanding HealthChoice The Maryland Department of Health is the part of the state government that oversees public health.; Medicaid is part of the Maryland Department of Health. Medicaid provides free or low …Check the box on your state tax form and get health coverage. Marylanders are eligible for a special enrollment period when they file their taxes and check a box on their state tax form. This special enrollment runs through tax season. Find out about health coverage through the Easy Enrollment program. You may be eligible for a special enrollment.Agency executive. Michele Eberle, executive director. Website. marylandhealthconnection.gov/. The Maryland Health Connection (administered by the Maryland Health Benefit Exchange) is the health insurance marketplace in the U.S. state of Maryland, created in accordance with the Patient Protection and Affordable Care Act. [1]Download our free mobile app, Enroll MHC, to submit documents using the camera of your mobile device. If you are unable to submit documents online, you may mail them to Maryland Health Connection, P.O. Box 857, Lanham, MD 20703. In some cases, you may sign and upload a written statement using an affidavit for different situations including: If ...privacy notice, visit MarylandHealthConnection.gov. For help filling out your application, general questions or to get connected with free in-person help, visit MarylandHealthConnection.gov/help or call our toll-free phone number at 1-855-642-8572. Deaf and hard of hearing use Relay service. Home > How to Enroll > How to Enroll in a Private Plan. 1. Shop and Compare. Use our Get an Estimate tool to compare plans and see if you may qualify for financial assistance. 2. Apply. Apply online at marylandhealthconnection.gov, Apply via our mobile app: Apple or Android. Apply over the phone 1-855-642-8572. Maryland Health Connection for Small Business. A program of Maryland Health Connection that enables small businesses and their employees to compare and shop for private health plans. This program is the only place where Maryland’s small businesses can get federal tax credits to lower their costs.Los habitantes de Maryland que se encuentren en Estados Unidos bajo ciertas condiciones migratorias o que hayan solicitado determinadas condiciones de presencia legal podrían ser elegibles para inscribirse en un plan de salud privado a través de Maryland Health Connection. Inscripción y Elegibilidad. web-homepage - Maryland Health Connection. Home. Finding the Right Plan with MHC. If I'm enrolled in a plan this year, do I need to shop again for next year? Medicare.gov. for plan information. If you’re eligible to enroll in coverage through Maryland Health Connection, you can enroll online at . MarylandHealthConnection.gov. You also can find free enrollment help near you at . MarylandHealthConnection.gov/help, or call . 1-855-642-8572 (TTY: 1-855-642-8573). marylandhealthconnection.gov Home > How to Enroll > How to Enroll in a Private Plan. 1. Shop and Compare. Use our Get an Estimate tool to compare plans and see if you may qualify for financial assistance. 2. Apply. Apply online at marylandhealthconnection.gov, Apply via our mobile app: Apple or Android. Apply over the phone 1-855-642-8572. Marylanders can apply during open enrollment Nov. 1-Jan. 15. Enroll Nov. 1-Dec. 31 for coverage beginning Jan. 1. Enroll Jan. 1-15 for coverage beginning Feb. 1. You can enroll in health coverage any time of year if you qualify for Medicaid, the Maryland Children's Health Program (MCHP) or MCHP Premium. Certain life events qualify you to enroll ...Marylanders who are present in the U.S. under certain immigration statuses or have applied for certain lawfully present statuses may be eligible to enroll in a private health plan …Enroll MHC provides Marylanders easy, on-the-go access to shop for health and dental coverage, compare plans, apply for financial help, find local assistance, update your information, view notices and even use your device's camera to upload documents. You can also go online to MarylandHealthConnection.gov.About this app. Enroll MHC is the official mobile app for Maryland Health Connection, Maryland’s health insurance marketplace for individuals and families to enroll in health and dental coverage. See if you qualify for financial help like tax credits or Medicaid/MCHP to make health insurance more affordable.Streamlined Medicaid Enrollment Portal. Medicaid Newborn Enrollment. Family Planning Presumptive Eligibility.marylandhealthconnection.gov . 한국어 /Korean . 사용하시는. 언어로. 지원해드립니다: 1-855-642-8572 (TTY: 1-855-642-8573). 무료로 제공 됩니다. Português/Portuguese . A ajuda está disponível em seu idioma: 1-855-642-8572 (TTY: 1-855-642-8573). Estes serviços são oferecidos de graça. Русский/Russian If you received a letter to reapply for Medicaid or if you think it’s time for you to do so, here are ways to renew your coverage: Renew online. Log into your account and use the Change My Information/Renew Coverage button. Use the free mobile app, Enroll MHC. Get help renewing your coverage. Se aceptan los siguientes tipos de documentos en MarylandHealthConnection.gov/ espanol para hacer verificaciones relacionadas con los ingresos, identidad, domicilio, Número de seguro social, ciudadanía o estatus migratorio.Home > How to Enroll > How to Enroll in a Private Plan. 1. Shop and Compare. Use our Get an Estimate tool to compare plans and see if you may qualify for financial assistance. 2. Apply. Apply online at marylandhealthconnection.gov, Apply via our mobile app: Apple or Android. Apply over the phone 1-855-642-8572.Agency executive. Michele Eberle, executive director. Website. marylandhealthconnection.gov/. The Maryland Health Connection (administered by the Maryland Health Benefit Exchange) is the health insurance marketplace in the U.S. state of Maryland, created in accordance with the Patient Protection and Affordable Care Act. [1] Our goal is to make health coverage affordable and more accessible for Marylanders. Maryland Health Benefit Exchange (MHBE) is responsible for the administration of Maryland Health Connection, the state’s health insurance marketplace, under the Patient Protection and Affordable Care Act of 2010 (ACA). MHBE works with Maryland Department of ... Find help in your area. Maryland Health Connection’s free, local navigators can be found at events throughout Maryland! Some events are for enrollment and other events have resources available. For questions about enrollment at a specific event, contact the Consumer Assistance Organization in your region.A time outside of the open enrollment period during which you and your family may have a right to sign up for health coverage. You qualify for a special enrollment period through Maryland Health Connection generally 60 days after certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of ...Visit MarylandHealthConnection.gov and use the Get an Estimate tool to see how much you may save. Medicaid enrollment is open year-round. Look up your household size and income below to see if you may qualify for free or low-cost coverage through Medicaid or Maryland Children’s Health Program. If you’re pregnant or youIf you suspect fraud in the state government, visit the OLA Fraud Hotline website. If you suspect that your personal information have been improperly used or disclosed, call the Maryland Health Benefit Exchange Compliance Hotline at 410-547-6862. To contact Maryland Health Connection’s Consumer Support Center, call 1-855-642-8572 (Deaf …How it works: 1. Receive information. MHC will contact you if you are eligible for this program to change from Medicaid to a private plan. You will receive information in the mail and in your account explaining what to do. You may also receive a bill from a health insurance company. You don’t have to pay the bill unless you want this health plan.For more information about Medicaid Check-In visit marylandhealthconnection.gov/checkin or health.maryland.gov/mmcp. ### The Maryland Department of Health is dedicated to protecting and improving the health and safety of all Marylanders through disease prevention, access to care, quality management and … Special Enrollment. Some life events qualify you to enroll in health coverage outside of open enrollment. Want to learn more about the latest info? Get text alerts! See if you qualify to enroll in health coverage now. The application is available daily from 6 a.m. to 11 p.m. Starting April 2023, anyone who needs to renew their Medicaid coverage will receive a notice from Maryland Health Connection or the Maryland Department of Human … 4 ways to get financial help: Medicaid or the Maryland Children’s Health Program (MCHP) Advance Premium Tax Credits (APTC) Cost-Sharing Reductions. Young Adult Premium Assistance. The amount of financial help you receive may vary based on your household income, family size, and ZIP code. You or members of your household could be eligible for ... Report Changes. It’s important to update your information right away if you’ve had changes in your household or income to be sure you are receiving the right coverage and financial help. Some of these changes may allow you to enroll in coverage through Maryland Health Connection or change plans outside of open enrollment.Hunt Valley, MD 21031. By Email: Complete and scan the Request for Case Review form and send an email to: [email protected]. By Phone: Call Maryland Health Connection at 1-855-642-8572 (Deaf and hard of hearing use Relay service) After the case review is completed, you will receive a notice explaining how to request a hearing at the ...Home > Cómo inscribirse. 1. Comprar y comparar. Utilice nuestra herramienta Obtener una Estimación para comparar planes y ver si puede calificar para recibir asistencia financiera. 2. Aplicar. Aplicar en línea en marylandhealthconnection.gov, Aplicar a través de nuestra aplicación móvil: Apple o Android. Aplicar por teléfono al 1-855-642 ...Streamlined Medicaid Enrollment Portal. Medicaid Newborn Enrollment. Family Planning Presumptive Eligibility.Medicaid enrollment is year-round. Apply at www.marylandhealthconnection.gov or download the free “Enroll MHC" mobile app. Call 855-642-8572 weekdays from 8 am to 6 pm to apply by telephone. Get connected to free expert help virtually or by telephone. Our Health Education and Advocacy Unit can assist consumers who have enrollment …A time outside of the open enrollment period during which you and your family may have a right to sign up for health coverage. You qualify for a special enrollment period through Maryland Health Connection generally 60 days after certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of ...Para actualizar la información de contacto en línea, ingrese a su cuenta en MarylandHealthConnection.gov. Si necesita restablecer la contraseña de su cuenta, contáctese con nuestra asistente virtual Flora o visite el enlace en la página de inicio de sesión. 2. Manténgase atento a los comunicados de Maryland Health Connection. Visit www.MarylandHealthConnection.gov, the official marketplace for Marylanders to shop, compare and enroll for health coverage. Page · Government organization. (855) 642-8572. marylandhealthconnection.gov. Check the box on your state tax form and get health coverage. Marylanders are eligible for a special enrollment period when they file their taxes and check a box on their state tax form. This special enrollment runs through tax season. Find out about health coverage through the Easy Enrollment program. You may be eligible for a special enrollment.Participants can log in to their account at MarylandHealthConnection.gov and update their address, phone number and email. Participants can also call Maryland Health Connection at 855-642-8572. Help is available in more than 200 languages. Deaf and hard of hearing use relay service. Report Changes. It’s important to update your information right away if you’ve had changes in your household or income to be sure you are receiving the right coverage and financial help. Some of these changes may allow you to enroll in coverage through Maryland Health Connection or change plans outside of open enrollment. 4 ways to get financial help: Medicaid or the Maryland Children’s Health Program (MCHP) Advance Premium Tax Credits (APTC) Cost-Sharing Reductions. Young Adult Premium Assistance. The amount of financial help you receive may vary based on your household income, family size, and ZIP code. You or members of your household could be eligible for ... Online at MarylandHealthConnection.gov. Visit a local connector entity, health department or department of social services. Download the free mobile app, Enroll MHC. Call Maryland Health Connection at 1-855-642-8572 (Deaf & Hard of Hearing Use Relay Service). Those found eligible for MCHP will receive an enrollment packet in the mail to …You also may contact Maryland Health Connection at www.marylandhealthconnection.gov or 1-855-642-8572. Important Note If someone is trying to sell you health insurance, make sure that the person selling the plan is licensed, and that you understand what the plan will and won't cover. The Maryland Insurance …Hunt Valley, MD 21031. By Email: Complete and scan the Request for Case Review form and send an email to: [email protected]. By Phone: Call Maryland Health Connection at 1-855-642-8572 (Deaf and hard of hearing use Relay service) After the case review is completed, you will receive a notice explaining how to request a hearing at the ...privacy notice, visit MarylandHealthConnection.gov. For help filling out your application, general questions or to get connected with free in-person help, visit MarylandHealthConnection.gov/help or call our toll-free phone number at 1-855-642-8572. Deaf and hard of hearing use Relay service.Dec 31, 2018 · MarylandHealthConnection.gov or call 1-855-642-8572. Deaf and hard of hearing use Relay service. How to Report Your Household Size and Income Adjusted Gross Income Foreign income Tax-exempt interest Non-taxable Social Security benefits (except for Supplemental Security Income) Modified Adjusted Gross Income (MAGI) Find affordable health insurance plans and apply online. Compare options and get free quotes. Maryland Health Connection is your state marketplace.Marylanders who are present in the U.S. under certain immigration statuses or have applied for certain lawfully present statuses may be eligible to enroll in a private health plan …Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked; Alcohol misuse screening and counseling; Aspirin use to prevent cardiovascular disease for men and women of certain agesEnroll on your own at www.MarylandHealthConnection.gov . Download the Enroll MHC app free from the Apple Store (IOS) and the Google Play Store (Android) If you need in-person assistance to complete the enrollment process, please see the locations and hours of operation below. Check out the "Documents Needed" section to be sure you have …hereby certify that the statements provided in this affidavit (explanation) of no income are true and accurate to the best of my knowledge. understand if I am determined eligible for Medicaid or a Qualified Health Plan I must report any and all changes (including changes in income, address, household members or pregnancy status) within 10 days ...1. Aplique Medicaid o MCHP. Aplique en línea en marylandhealthconnection.gov, Aplique a través de nuestra aplicación móvil: Apple o Android. Aplique por teléfono al 1-855-642-8572. Solicite una solicitud en papel llamando al 1-855-642-8572. Infórmese acerca de a quién incluir en su hogar, cómo calcular los ingresos de su hogar y qué ...
Streamlined Medicaid Enrollment Portal. Medicaid Newborn Enrollment. Family Planning Presumptive Eligibility. . Advanced search google
Jan 21, 2015 · Online at www.marylandhealthconnection.gov. Note: Recipients renewing their Medicaid benefits should be sure to complete all questions in the “Special Enrollment” section of the application. By calling the Maryland Health Connection Call Center at 1-855-642-8572 (TTY: 1-855-642-8573). 2024 Value Plans Side-by-Side. * Depending on your income, you may be eligible for extra savings when you enroll in a Silver plan. For a household of one, the deductible would be $0 if income is between $20,121 - $21,870; $1,000 if income is between $21,871 to $29,160; or $4,500 if income is between $29,161 - $36,450. Affidavit of Self-Employment Income. Note: If you have operated your business for at least a year and have a signed copy of the most recent year’s Federal Tax Return including all schedules and attachments, AND you do not anticipate your income will change by more than 10 percent in the coming year, supply your complete tax return and do not ... Dental Coverage. Home > Dental Coverage. Benefits that help pay for the cost of visits to a dentist for basic or preventive services, like teeth cleaning, X-rays, and fillings. Finding the Right Plan with MHC.A time outside of the open enrollment period during which you and your family may have a right to sign up for health coverage. You qualify for a special enrollment period through Maryland Health Connection generally 60 days after certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of ... MarylandHealthConnection.gov l Visit your local Department of Social Services l Call 1-855-642-8572. Deaf and hard of hearing use Relay service l Find free, in-person help near you at MarylandHealthConnection.gov/help l Download our free mobile app, Enroll MHC What benefits are covered through Medicaid? You can buy a dental-only plan or a health plan that includes dental on Maryland Health Connection during open enrollment Nov. 1 to Jan. 15. Certain life events qualify you to enroll in a dental plan outside of open enrollment. If you qualify, you may enroll in Medicaid any time of year. Dental care is free for anyone enrolled in Medicaid or MCHP.Participant Check-In. Keep Your Info Current. Keep Yourself Insured. Maryland Medicaid Renewal is NOT automatic. During the COVID-19 public health emergency, Marylanders who were enrolled in Medicaid continued to be covered, even if they were no longer eligible. Starting in April 2023, Maryland began making Medicaid eligibility reviews again. Inscripción Especial. Hay acontecimientos de la vida que lo califican para inscribirse en la cobertura de salud fuera del plazo de la inscripción abierta. ¿Quiere saber más sobre la información más reciente? Reciba alertas de texto. Verifique ahora mismo si usted califica para inscribirse a un plan de salud. La solicitud está disponible ... See if you qualify to enroll in health coverage now. The application is available daily from 6 a.m. to 11 p.m.www.marylandhealthconnection.gov. If you are unable to submit these documents . online, you may mail them to Maryland Health Connection, P.O. Box 2160, Manchester, CT 06045. If you have questions about acceptable documentation, please call 1-855-642-8572 (TTY: 1-855-642-8573).marylandhealthconnection.gov . ngữ của quí vị. Gọi số1 -855 642 8572 (Người điếc và lãng tai có thsểửdụng dịch vụ Chuyển Tiếp (Relay)). Những dịch vụ này có sẵn miễn phí. yorùbá/Yoruba . Àkíyèsí yìí ní ìfitónilétí pàtàkì nípa kíkópa … There are several programs under Maryland Medicaid. Each program provides one of three types of medical assistance to serve the health needs of different eligible groups of people : You can apply for Medicaid at any time. If you are eligible, you can enroll year-round. Individuals who receive Supplemental Security Income (SSI) are automatically ... Report Changes. It’s important to update your information right away if you’ve had changes in your household or income to be sure you are receiving the right coverage and financial help. Some of these changes may allow you to enroll in coverage through Maryland Health Connection or change plans outside of open enrollment. Enter the deductible portion of tuition and fees for yourself or qualifying dependents. The maximum deductible allowed is $2,000 or $4,000 depending on income. For additional information, see IRS publication 970. Enter your health savings account contributions. Enter your penalties on the early withdrawal of savings.get help signing up for a health plan. To find a location near you, visit MarylandHealthConnection.gov/help. You can also call us at 1-855-642-8572 (deaf and hard of hearing use Relay service). A health insurance expert who speaks your language is only a phone call away.enrollment through your account at MarylandHealthConnection.gov. Now, you can go online to end your coverage, including a health plan, Medicaid, or dental coverage. You also may end coverage by faxing or mailing the Coverage Termination Form (PDF), calling our consumer support center at 1-855-642-8572, or getting free, in-person help.The persistent cookies used with third-party tools on MarylandHealthConnection.gov can be stored on a user’s local system and are set to expire at varying time periods depending upon the cookie. ... In the event we are required to disclose your personal information to another government agency, a qualified health plan or any other non ...Social Security Numbers (or document numbers for legal immigrants) Citizenship or immigration status. Tax returns for previous years. Employer and income info (pay stubs, W-2 forms) Policy numbers for any current health insurance and information about employer-sponsored coverage you or someone in your household is eligible for.Affidavit of Self-Employment Income. Note: If you have operated your business for at least a year and have a signed copy of the most recent year’s Federal Tax Return including all schedules and attachments, AND you do not anticipate your income will change by more than 10 percent in the coming year, supply your complete tax return and do not ....