Federal Checklist for Enrollment

Download and Print the Federal 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 current North Carolina driver's license or state ID
• current rent or mortgage payment receipt
• voter's registration card
• state income tax return
• car registration
• property tax receipt
• 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 current North Carolina driver's license or state ID (can use for both NC and US Residency)
• naturalization/ citizenship certificate
• Visa
• green card
• I-94 card
• Employment Authorization Document (EAD) and Advance Parole (Temporary travel document)

4. Proof of Eligibility:

• 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

5. Other documentation (if applicable):

• a disability award letter
• a letter from a physician confirming the diagnosis of one of the Presumptive Medical Conditions.
• Healthcare Savings Account Banking set-up form, if using HSA Banking option through the Inclusive Health Plan