Health Coverage & Help Paying Costs - Kynect 2026

1. Click ‘Get Form’ to open the Health Coverage & Help Paying Costs - Kynect application in the editor.
2. Begin by filling out the 'Tell Us about Yourself' section. Enter the Responsible Party's first name, middle initial, last name, and suffix as it appears on their Social Security card. Provide the Social Security Number (SSN) if applicable.
3. Indicate whether you want coverage by checking the appropriate box. Complete all relevant questions regarding personal details such as date of birth, gender, and home address.
4. Proceed to list other household members in Step 2. Include their names, relationships, and SSNs if they are applying for coverage. Ensure all required fields are filled accurately.
5. In Step 4, provide income information from jobs held by household members. Specify gross amounts and frequency of payment to ensure accurate assessment of eligibility for assistance.
6. Finally, review your entries for accuracy before signing and dating the application in Step 5. Submit your completed form via mail or fax as instructed.

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