What do I need? Why do I need this? Is it ready? Your Marketplace application will ask if anyone in your household is currently enrolled in health coverage, including Medicaid, the Children’s Health Insurance Current health Program (CHIP), Medicare, TRICARE, VA health care program, Peace Corps, coverage COBRA, retiree insurance, or coverage through individual insurance (including information Marketplace coverage) or an employer. If anyone has coverage now, you may need to enter their policy numbers. You can 昀椀nd this information on their insurance card or documents they get from their plan. Your Marketplace application will ask you for information about any job-based Employer plan you or anyone in your household is eligible for. It will ask you for employer information for contact information for each person in your household who has a job. You can each person in your use the Employer Coverage Tool to help collect this information. You’ll want to 昀椀ll household out this worksheet for each member of your family who’s eligible for traditional health coverage through a job, even if that person isn’t enrolled in the job-based plan or isn’t applying for Marketplace coverage. Health Reimbursement Arrangement (HRA) notice (this only If someone works for a business that o昀昀ers help paying for a health plan or applies if anyone health care expenses through an individual coverage HRA or quali昀椀ed small in your household employer HRA, use the notice from the employer to complete your Marketplace application. Visit HealthCare.gov/job-based-help to learn more. is o昀昀ered an HRA through their employer) HOW CAN I LEARN MORE? To learn more about coverage through the Marketplace or your bene昀椀ts and protections, visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325. You have the right to get Marketplace information in an accessible format, like large print, braille, or audio. You also have the right to 昀椀le a complaint if you feel you’ve been discriminated against. Visit CMS.gov/about-cms/agency-information/aboutwebsite/cmsnondiscriminationnotice, or call the Marketplace Call Center at 1-800-318-2596 for more information. TTY users can call 1-855-889-4325. CMS Product No. 11896 September 2022 This product was produced at U.S. taxpayer expense. ® is a registered service mark of Health Insurance Marketplace the U.S. Department of Health & Human Services.