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0116 Rev 516 Rev2 318  Form

0116 Rev 516 Rev2 318 Form

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Health Insurance Program (CHIP) You may qualify for a free or low-cost program even if you earn as much as $94,000 a year (for a family of 4) Who can use this application?   Use this application to apply for anyone in your family Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage If you’re single, you may be able to use a short form. Visit Families that include immigrants can apply. You can apply for your child...
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