Skip Navigation Accessibility

Forms & Resources

File Type Modified
No results found, please try again.
Individuals & Families Forms & Resources File Type Modified
Application Form for Coverage with Financial Assistance for Families
Application Form for Coverage with Financial Assistance for Individuals
Application Form for Coverage without Financial Assistance
Employer Coverage Tool (for use with filling out assistance applications)
2017 Benchmark Plan Premium Costs
2016 Benchmark Plan Premium Costs
2015 Benchmark Plan Premium Costs
2014 Benchmark Plan Premium Costs
Calculating Net Self-Employment Income
Eligible Immigration Status List
Authorized Representative Form
Individuals and Families Checklist
Application for Exemption
Decline Medicaid Coverage Form
Medicaid Coverage of Past Medicaid Bills
Employer forms & resources File Type Modified
New Employers Creating an Account
Existing Employers First Login to Updated DC Health Link
Employers Manage Your Employee Roster
Employee Roster Template
Employers Enrolling as Employees
Employers Pay Your Premiums Online
Deadlines for Employer-Sponsored Coverage
Small Business Chart Check List
Guidance for Business Owners
Employer Appeal Request Form
Employer Renewal Guide
Employer Religious Exemption Application EBSA Form 700
Small Groups being Renewed on DC Health Link by their Carrier
Assigning a Broker
Brokers Assigning a GA
Managing Employer Points of Contact
Checklist for Migrating Employers
Enrolling in COBRA
Employee forms & resources File Type Modified
New Employees How to Enroll in a Plan through DC Health Link
Existing Employees First Login to Updated DC Health Link
Employee Appeal Request Form
Qualifying Life Events (QLEs) - Removing a Dependent
Qualifying Life Events (QLEs) - Enrolling in a New Plan
Qualifying Life Events (QLEs) - Adding a Dependent
Qualifying Life Events (QLEs) - Terminating Coverage
Employee Renewal Open Enrollment Guide
appeals forms & resources File Type Modified
Individual & Families Appeals Rights
Eligibility Appeal Request Form
D.C. Health Care Ombudsman Homepage
Health Benefits Plan Grievances & Appeals Fact Sheet
Printable Appeals Form
Printable Disclosure and Authorization Form
complaint forms & resources File Type Modified
How To File a Commercial Insurance Complaint or Report Fraud
Printable Complaint Form
Online Consumer Complaint Form
tax forms & resources File Type Modified
2016 View the Form 1095-A cover letter
2015 View the Form 1095-A cover letter
2014 View the Form 1095-A cover letter
2016 Request a Corrected Form 1095-A
2015 Request a Corrected Form 1095-A
2014 Request a Corrected Form 1095-A
2016 Lowest Cost Bronze Plan Premium Costs
2015 Lowest Cost Bronze Plan Premium Costs
2014 Lowest Cost Bronze Plan Premium Costs
የግለሰብ እና የቤተሰብ የፋይል ዓይነት የታረመ
ለጤና ሽፋን ማመልከቻ
ግለሰቦች እና ቤተሰቦች መቆጣጠሪያ ዝርዝር
2017 “ሁለተኛው ዝቅተኛው ወጪ ሲልቨር ፕላን”
ነጻ ለመሆን (ለኤግዘምፕሽን) ማመልከቻ
ለግል/ለቤተሰብ የጤና ሽፋን የይግባኝ መጠየቂያ
የአነስተኛ ንግድ ድርጅት ወይም የሰራተኛ የፋይል ዓይነት የታረመ
አዲስ ቀጣሪዎች በዲሲ ሄልዝ ሊንክ በኩል የጤና ሽፋን እንዴት ማቅረብ እንደሚችሉ
አዲስ ተቀጣሪዎች - በዲሲ ሄልዝ ሊንክ በኩል ለጤና ሽፋን እንዴት መመዝገብ እንደሚቻል
የጤና ሽፋኖንበዲሲ ሄልዝ ሊንክ በኩል ማሳደስ
የተቀጣሪዎን ዝርዝር(ሮስተር)
ለተቀጣሪ ማሳደሻ ክፍት ምዝገባ የዲሲ ሄልዝ ሊንክ መምሪያ(ጋይድ)
个人和家庭 文件类型 修改
健康保险申请表
个人与家庭申请清单
2017 年“次低费用白银计划” 费用
无法负担保险
个人/家庭健康保险的上诉请求
小型企业或员工 文件类型 修改
新雇主 — 如何通过 DC Health Link 提供健康保险
新员工 ‐ 如何通过 DC Health Link 注册健康保险
雇主 对您的健康保险进行续保
管理您的员工名单
员工续约开放参保指南
Individuelle et familiale Type de fichier Modifié
Demande d'Assurance santé
Liste de contrôle pour les particuliers et les familles
Les tarifs du plan de reference - 2017
Demande d'exonération
Demande d’appel pour assurance santé individuelle/famille
Petite entreprise ou employé(e) Type de fichier Modifié
Nouveaux employeurs - Comment offrir une couverture médicale
Nouveaux employés – Comment souscrire une couverture médicale
Renouvellement de la couverture médicale par le biais de DC Health Link
Gestion de votre liste
Période de renouvellement d'inscription des employés guide
Individual y Familiar Tipo de Archivo Modificado
Solicitud de cobertura de seguro médico
Solicitud para la cobertura de salud y ayuda para el pago de costos
Los costos del plan de referencia - 2017
Solicitud de apelación para cobertura de seguro médico individual/familiar
Forma representante autorizado
Lista de control para individuos y familias
Solicitud de exención
Pequeña Empresa o Empleado Tipo de Archivo Modificado
Solicitud de cobertura del empleador
Nuevos empleadores: cómo ofrecer cobertura de seguro médico
Nuevos empleados: cómo inscribirse para obtener cobertura de seguro médico
Renovación de su cobertura de seguro médico
Administración de la lista de empleados
Inscripción abierta de renovación del empleado guía
Aplicaciones Tipo de Archivo Modificado
Lista de estatus inmigratorios elegibles
Individuos y Familia Lista de Verificacion
Pequena Empresa Lista de Verificacion