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Relationship	Date of Birth (mm/dd/yyyy)	Gender	Tobacco Use What Is This?
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent
Relationship to Applicant	Applicant's Date of Birth (Enter as mm/dd/yyyy)	Applicant's Gender	Has Applicant Used Tobacco In The Past?	Remove This Dependent

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The Affordable Care Act provides advanced premium tax credits (subsidies) to help qualified people pay for health insurance coverage. These subsidies are primarily based on household income and the number of people in the household. Use our Subsidy Tool to see if you are eligible and get an estimated subsidy amount to apply towards your monthly plan premiums.

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CWS SHP 006 NF 092016

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Want to see if you are eligible for a subsidy?

Want to see if you are eligible for a subsidy?