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Enrollment Checklist
Download the Checklist
If you are coming to the Enrollment Event and want to enroll with Inclusive Health, you will need to bring:
1. A voided check with banking information for an EFT (Electronic Funds Transfer)
2. One form of identification to show state residency:
- a. a current North Carolina driver's license or state ID
- b. current rent or mortgage payment receipt
- c. voter 's registration card
- d. state income tax return
- e. car registration
- f. property tax receipt
- g. utility bill
3. Proof of US Citizenship or Lawful Permanent Resident Alien:
If you are NOT a citizen of the United States, you are required to provide:
- a. a current North Carolina driver's license or state ID (can use for both NC and US Residency)
- b. naturalization/ citizenship certificate
- c. Visa
- d. green card
- e. I-94 card
- a. Employment Authorization Document (EAD) and Advance Parole (Temporary travel document)
4. Proof of Federally Eligible HIPAA individual (if you have had continuous coverage):
- a. a copy of a Certificate of Creditable Coverage showing 18 months of continuous coverage from your prior carrier
- b. if your prior carrier has not provided your with a certificate, other examples of proof of coverage may include:
- i. explanation of benefits or other correspondence from a plan or insurer indicating coverage
- ii. pay stubs showing a payroll deduction for health coverage
- iii. health insurance identification card
- iv. certificate of coverage for group health policy
5. Proof of creditable coverage to reduce pre-existing condition waiting period:
- a. a copy of a Certificate of Creditable Coverage showing 18 months of continuous coverage from your prior carrier
- b. if your prior carrier has not provided your with a certificate, other examples of proof of coverage may include:
- i. explanation of benefits or other correspondence from a plan or insurer indicating coverage
- ii. pay stubs showing a payroll deduction for health coverage
- iii. health insurance identification card
- iv. certificate of coverage for group health policy
6. Proof of Health Coverage Tax Credit (TAA or ATAA) or Pension Benefit Guaranty Corporation
- a. Copy of one of the following:
- i. TAA or ATAA Certification
- ii. health Coverage Tax Credit Certificate or letter indicating eligibility
- iii. proof of certification by Pension Benefit Guaranty Corporation
7. Proof of Eligibility:
- a. a letter from an individual health insurer that includes one of the following:
- i. denial or rejection due to a medical condition from the health insurer
- ii. a conditional rider that would exclude coverage for a medical condition
- iii. a premium statement or a letter showing a COBRA or state continuation premium rate that exceeds the rate you would be charged by Inclusive Health
- iv. a premium rate that exceeds the Inclusive Health rate.
8. Other documentation (if applicable):
- a. a disability award letter
- b. COBRA termination letter including the reason for termination
- c. Pre-existing condition waiting period letter from a health carrier indicating when pre-existing limitation no longer applies to you
- d. Healthcare Savings Account Banking set-up form, if using HSA Banking option through the Inclusive Health Plan.
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