Enrollment Checklist

When you apply for MDwise Marketplace health insurance, you’ll need to provide some information about you and your household.

Use the checklist below to help you gather what you need to apply for coverage.

Home and/or mailing addresses for everyone applying for coverage.

Social Security Numbers or document numbers for legal immigrants.

Employer and income information for every member of your household who needs coverage. For example, information from pay stubs or W-2 forms.

Your best estimate of what your household income will be.

A completed Employer Coverage Tool form for every job-based plan you or someone in your household is eligible for. You’ll need to fill out this form even for coverage you’re eligible for, but don’t enroll in.

Notices from your current plan that include your plan ID, if you have or had health coverage in the             last year.