Submit Documents

You may need to submit documents when you apply for a health plan. This happens when some of your information cannot be verified. This is called “conditional eligibility.”

If you are conditionally eligible, you must submit your documents by a deadline. You may lose your coverage or financial support if you do not.

You can find the documents you need in the Document Center of your account. Below are common documents that may be needed. You can also view a full list of accepted documents (PDF).

You can submit your documents online, by fax or by mail. Washington Apple Health (Medicaid) customers can submit documents to the Washington Health Care Authority (HCA). Below we provide instructions for each method.

Online

You can submit documents online with your Washington Healthplanfinder account. Uploading documents is easy with your computer or mobile device. The documents you need to submit will be shown in the Document Center.

1. Sign in to your account.
2. Select the “Document Center” tab.
3. Select “Upload.”

Mail or fax

You can fax or mail a copy of your documents to us. We cannot return original documents. Mailing your documents will delay the process.

Fax: 360-841-7620

Mail:

Washington Healthplanfinder

P.O. Box 946

Olympia, WA 98507

Important: Do not mail your documents if your deadline is less than two weeks away.

Apple Health customers

Apple Health customers can also send documents to the Washington Health Care Authority (HCA).

Email: [email protected]

Fax: 1-855-867-4467

Forms

Exception to verification for income

Use this form to explain your household income or deductions.

• Exception to Eligibility in Special Circumstances - English (PDF)
• ការលើកលែងការបញ្ជាក់ភាពមានសិទ្ធិទទួលបានក្នុងស្ថានភាពពិសេស - Cambodian (Khmer) (PDF)
• 特殊情况中资格验证的例外情形 - 简体 Chinese - simplified (PDF)
• 특수상황에 대한 자격증명 예외 신청서 - Korean (PDF)
• ການຍົກເວັ້ນຕໍ່ການພິສູດເງື່ອນໄຂຮັບເອົາໃນສະພາບການພິເສດ - Lao (PDF)
• Исключения при проверке прав в особых обстоятельствах – Russian (PDF)
• Ka-reebnaanta Xaqiijinta U-qalmitaanka Daruufaha Gaarka ah – Somali (PDF)
• Excepción a la verificación de elegibilidad en circunstancias especiales – Spanish (PDF)
• Ngoại Lệ đối với Sự Xác Minh Việc Hội Đủ Điều Kiện trong Các Trường – Vietnamese (PDF)

Declaration of ineligibility for other health insurance coverage

Use this form to verify that you or a household member isn't eligible for other coverage.

• Declaration of Ineligibility for Other Health Insurance Coverage - English (PDF)
• ការប្រកាសនៃភាពមិនមានសិទ្ធិទទួលបានសម្រាប់ធានារ៉ាប់រងសុខភាពផ្សេងទៀត - Cambodian (Khmer) (PDF)
• 其他健康保险范围的不合格声明 - 简体 Chinese - simplified (PDF)
• 기타 건강 보험 보장 수혜 부적격 선언서 - Korean (PDF)
• ການແຈ້ງການຂອງການບໍ່ມີເງື່ອນໄຂໄດ້ຮັບການຄຸ້ມກັນປະກັນພັຍສຸຂະພາບແນວອື່ນ - Lao (PDF)
• Форма декларации об отсутствии права на участие в другой программе  - Russian (PDF)
• Ku Dhawaaqidda U-qalmid La'aanta Caynsanaanta Caymiska Caafimaad Kale - Somali (PDF)
• Declaración de no elegibilidad para otra cobertura de seguro de salud - Spanish (PDF)
• Cam Kết Việc Không Hội Đủ Điều Kiện Hưởng Bao Phí Bảo Hiểm Y Tế - Vietnamese (PDF)

Proof of non-incarceration

Use this form to verify that you or a household member isn't incarcerated in a city, county, state, or federal jail or prison.

• Declaration of Non-Incarceration Status Form - English (PDF)
• ការប្រកាសបែបបទស្ថានភាពមិនជាប់ពន្ធធានាគារ - Cambodian (Khmer) (PDF)
• 非监禁状态表格声明 - 简体 Chinese - simplified (PDF)
• 비투옥 상태 선언서 - Korean (PDF)
• ໃບຟອມສະພາບຂອງການແຈ້ງການຂອງການບໍ່ຖືກຄຸມຂັງ - Lao (PDF)
• Форма декларирования статуса лица, не находящегося в местах лишения  - Russian (PDF)
• Foomka Ku Dhawaaqidda Xaalka Xabisnaan La'aanta - Somali (PDF)
• Formulario de declaración de situación de no encarcelamiento - Spanish (PDF)
• Mẫu Đơn Cam Kết Tình Trạng Không Bị Tống Giam - Vietnamese (PDF)

Tribal statement of good faith effort 

Use this form to explain why you're unable to prove your membership in a federally recognized Tribe or Alaska Native Corporation.

• Statement of Good Faith Effort - English (PDF)

Documents need to be submitted by a deadline. You will be notified of this deadline if we need documents from you.

If you miss this deadline, your coverage will end. You could also lose your tax credits or the amount of tax credits you're eligible for could change. You will have to wait until the next open enrollment period to sign up again. This is not the case if you qualify for special enrollment.